CPT® Code 46707

The procedure described by CPT® Code 46707 involves the repair of an anorectal fistula using a plug, specifically a porcine small intestine submucosa (SIS). An anorectal fistula is an abnormal connection between the anal canal and the skin surrounding the anus, which can lead to discomfort and recurrent infections. The use of a plug for repair is considered a minimally invasive technique, which typically results in fewer complications compared to traditional surgical methods. During the procedure, the surgeon identifies both the internal and external openings of the fistula tract. The fistula is then curetted, which means that the tissue within the tract is scraped out to promote healing, and it is irrigated with an antibiotic solution to reduce the risk of infection. If a porcine SIS plug is utilized, it is prepared by rolling a 4-ply sheet of SIS tightly and securing the edge with sutures. The ends of the plug are then attached to suture ligatures, which are used to pull and position the plug within the fistula tract. After positioning, the plug is trimmed to be flush with the internal opening of the fistula, which is subsequently closed with sutures. In some cases, a sliding mucosal flap may be employed as an alternative method to close the internal opening. The expected healing time for the fistula is approximately five weeks, during which the plug facilitates the closure of the abnormal connection.