43283 Laparoscopy, surgical, esophageal lengthening procedure (eg, Collis gastroplasty or wedge gastroplasty) (List separately in addition to code for primary procedure)

Name of the Procedure:

Laparoscopy, surgical, esophageal lengthening procedure (e.g., Collis gastroplasty or wedge gastroplasty)

Summary

This is a minimally invasive surgical technique used to lengthen the esophagus. The procedure involves the use of small incisions and specialized instruments to perform the surgery, which allows for quicker recovery and less post-operative pain.

Purpose

The procedure is primarily used to treat esophageal conditions like short esophagus, most often associated with severe gastroesophageal reflux disease (GERD) or esophageal stricture. The primary goal is to increase the length of the esophagus, ensuring it is properly anchored in the abdomen and reducing symptoms like heartburn and regurgitation.

Indications

• Chronic and severe GERD that is unresponsive to medication
• Esophageal stricture
• Short esophagus confirmed via diagnostic imaging
• Symptomatic hiatal hernia
• Prior esophageal surgeries that did not provide relief

Preparation

Patients are usually instructed to fast for at least 8 hours before the procedure. They may need to adjust certain medications, especially blood thinners, per their doctor’s advice. Pre-operative tests may include blood work, esophagrams, endoscopy, and manometry to assess the esophagus.

Procedure Description

1. The patient will be under general anesthesia.
2. Small incisions are made in the abdomen.
3. A laparoscope (a small camera) and specialized instruments are inserted through these incisions.
4. The surgeon will lengthen the esophagus by performing a gastroplasty, which could involve reshaping part of the stomach to form an extension of the esophagus.
5. In the case of Collis gastroplasty, a vertical incision on the stomach is made to create the necessary length.
6. Incisions are closed after the esophagus has been lengthened and secured.

Duration

The procedure typically takes 2 to 3 hours.

Setting

This procedure is performed in a hospital, typically in an operating room equipped for laparoscopic surgery.

Personnel

• Surgeon specialized in laparoscopic and gastrointestinal surgeries
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the incision sites
• Bleeding
• Injury to surrounding organs
• Difficulty swallowing (dysphagia)
• Anastomotic leak (leakage from the surgical join in the esophagus or stomach)
• Recurrence of GERD symptoms
• General anesthesia risks

Benefits

• Relief from chronic GERD symptoms
• Improved swallowing function
• Reduced risk of esophageal stricture
• Enhanced quality of life with fewer esophageal issues Benefits can often be realized within a few weeks after surgery, following the recovery period.

Recovery

• Hospital stay of 1-3 days post-surgery
• Maintain a soft or liquid diet for several days or weeks
• Gradual reintroduction of solid foods as advised by the doctor
• Avoid heavy lifting or strenuous activity for several weeks
• Follow-up appointments to monitor recovery and ensure the success of the procedure

Alternatives

• Medical management of GERD with medications like proton pump inhibitors (PPIs)
• Fundoplication surgery for GERD
• Endoscopic treatments
• Lifestyle and dietary changes Each alternative has its pros and cons, with the laparoscopic esophageal lengthening being a more permanent solution for appropriate cases.

Patient Experience

Patients will typically experience some discomfort and soreness at the incision sites post-surgery. Pain is usually managed with prescribed pain medications. Nausea may occur but is often temporary. During recovery, patients must adhere to dietary restrictions and follow post-operative care instructions to ensure proper healing.