CPT® Code 43405

The procedure described by CPT® Code 43405 involves the surgical intervention at the gastroesophageal junction, specifically targeting a pre-existing esophageal perforation. This condition typically arises when there is a tear or hole in the esophagus, which can lead to serious complications such as infection or leakage of esophageal contents into the surrounding areas. The surgical approach begins with a right posterolateral thoracotomy, which is a surgical incision made in the chest to access the esophagus. The skin is carefully incised, and the incision is extended through the underlying soft tissues to provide adequate exposure. During this process, the scapula is retracted to facilitate entry into the thoracic cavity without damaging the pleura, the membrane surrounding the lungs. Once inside the thorax, a retropleural dissection is performed, allowing the lung to be retracted and the perforation at the gastroesophageal junction to be clearly visualized. Alternatively, a transhiatal abdominal approach may be employed, which involves accessing the esophagus through the abdominal cavity. This method also requires careful dissection of the esophagus and stomach from surrounding tissues to enable thorough inspection and repair of the defect. Any ragged or necrotic tissue present around the perforation is meticulously debrided to promote healing and prevent infection. The final step of the procedure involves repairing the perforation through ligation or stapling, effectively closing the defect and restoring the integrity of the esophagus. After the repair, the thoracic or abdominal incision is closed, completing the surgical intervention.