CPT® Code 46288

The procedure described by CPT® Code 46288 involves the closure of an anal fistula using a rectal advancement flap technique. This surgical approach is specifically indicated for high perianal fistulas, which are located in the upper two-thirds of the external anal sphincter. High perianal fistulas present a unique challenge in surgical management, as traditional methods such as opening or excising the fistula can lead to significant complications, particularly the risk of incontinence due to disruption of the external anal sphincter. The procedure begins with the identification of the external opening of the fistula, followed by the insertion of a probe to accurately locate the internal opening. Once identified, the internal opening is excised to facilitate proper closure. The surgical technique involves mobilizing the mucosa and submucosa, along with a small amount of muscle fibers, from the internal sphincter. It is crucial to maintain a sufficiently wide base for the flap to ensure adequate blood supply and healing. After curettage of the fistula tract, the internal opening is intentionally left open to promote drainage. The advancement flap is then sutured over the internal fistula opening to achieve closure. In some cases, fibrin glue may be applied through the external opening to enhance the sealing of the flap, ensuring that the integrity of the flap is not compromised during this process.