CPT® Code 46735

1. Indications

The procedure associated with CPT® Code 46735 is indicated for the surgical repair of a high imperforate anus without fistula. This condition is typically diagnosed in newborns and may present with symptoms such as an absence of a visible anal opening, abdominal distension, or failure to pass meconium within the first 24 hours of life. The surgical intervention aims to correct the anatomical defect and establish a functional anal opening, which is essential for normal bowel function.

• High Imperforate Anus This condition is characterized by the absence of a proper anal opening, necessitating surgical intervention to create a functional anal passage.

2. Procedure

The surgical procedure for CPT® Code 46735 involves several critical steps to ensure the successful repair of the high imperforate anus. The first step is to make an incision posterior to the anorectal muscles in the perineum. This incision allows access to the presacral space, where dissection is performed to identify the rectal pouch. Care is taken to completely separate the rectum from any attachments to the genitourinary tract, which is crucial for preventing complications during the repair.

• Step 1: An incision is made posterior to the anorectal muscles in the perineum, facilitating access to the presacral space.
• Step 2: Dissection continues until the rectal pouch is identified, ensuring that the rectum is completely mobilized.
• Step 3: An abdominal incision is then made to inspect the abdominal cavity. The proximal aspect of the rectum is exposed, and the superior rectal vessels are located and protected during the procedure.
• Step 4: The ureters are also identified and protected to avoid any injury during the dissection.
• Step 5: The peritoneum is incised, allowing entry into the presacral space. Dissection continues through both the abdominal and perineal incisions until the rectum is fully mobilized.
• Step 6: Once the rectum is adequately mobilized, it is pulled through to the area of the anal sphincter, preparing for the final steps of the anoplasty.
• Step 7: The abdominal incision is then closed, and the anoplasty is completed by suturing the rectal mucosa circumferentially to the skin to create the new anal opening.

3. Post-Procedure

After the completion of the procedure, post-operative care is essential for recovery. Patients are typically monitored for any signs of complications, such as infection or issues with bowel function. The surgical site will require appropriate care to promote healing, and follow-up appointments will be necessary to assess the success of the repair and the functionality of the newly created anal opening. Patients may also need guidance on dietary modifications and bowel management strategies to ensure optimal recovery and prevent constipation or other bowel-related issues.