CPT® Code 46710

The CPT® Code 46710 refers to the surgical procedure for the repair of an ileoanal pouch fistula or sinus, which may occur in areas such as the perineum or vagina. This procedure is performed using a transperineal approach, meaning that the incision is made through the perineum, the area between the anus and the genitals. The primary goal of this surgery is to address complications arising from the ileoanal pouch, which is a surgically created reservoir for stool following the removal of the colon. In this procedure, the surgeon makes an incision around the anus to access the affected area. Residual anal mucosa, which may contribute to the fistula or sinus, is excised to facilitate a clean surgical field. An anoscope, a tubular instrument used for examining the anal canal, is inserted to identify the distal anastomosis site, which is the connection point between the ileoanal pouch and the anal canal. To ensure proper healing and minimize bleeding, epinephrine is injected below this site. The surgeon then mobilizes the distal aspect of the pouch while carefully protecting the internal sphincter, which is crucial for maintaining anal continence. The dissection continues proximally to fully mobilize the pouch and locate the proximal anastomosis site. During this process, the fistula or sinus is also divided, allowing for further access. The dissection is extended approximately 6-10 cm beyond the proximal anastomosis site to ensure complete removal of the affected tissue. The surgeon then locates, excises, and debrides the vaginal or perineal end of the fistula or sinus tract. After this, the tract is closed in layers to promote healing. The distal end of the pouch is trimmed, and the anal transitional zone or fistula site is excised. Finally, the new distal aspect of the pouch is sutured to the anus at the dentate line, which is the junction between the anal canal and the rectum, ensuring a secure and functional connection.