CPT® Code 46740

1. Indications

The procedure described by CPT® Code 46740 is indicated for patients presenting with a high imperforate anus accompanied by a rectourethral or rectovaginal fistula. This condition is typically diagnosed in newborns and may manifest with symptoms such as:

• Failure to pass meconium: Newborns with an imperforate anus may not pass the first stool, known as meconium, within the first 24 to 48 hours of life.
• Abdominal distension: The accumulation of stool and gas can lead to noticeable swelling of the abdomen.
• Fistulous tracts: The presence of abnormal connections between the rectum and the urinary or reproductive tracts may be observed, which can lead to complications such as urinary tract infections or fecal incontinence.

2. Procedure

The surgical procedure for CPT® Code 46740 involves several critical steps to repair the high imperforate anus and associated fistula. The process begins with the identification of the anorectal muscle complex using a muscle-stimulating device, which aids in ensuring accurate dissection. The surgeon makes an incision either anterior to the anorectal muscles in the perineum or posterior to them, depending on the approach chosen. This incision allows access to the presacral space, where dissection continues until the rectal pouch is located. Care is taken to mobilize the rectal pouch while completely separating it from any attachments to the genitourinary tract. As the dissection progresses, the rectourethral or rectovaginal fistula is identified, and the fistulous opening within the rectum is severed. The fistulous tract is then excised, and the wound is closed. Following this, the muscle stimulator device is used again to mark the anterior and posterior limits of the anorectal muscle complex. The rectum is sutured to the anorectal muscle complex to ensure proper anatomical alignment. The initial incision, whether perineal or sacroperineal, is then closed. To create the anal opening, the skin over the anal sphincter is incised, and the rectal pouch is opened. The rectal mucosa is sutured circumferentially to the skin, establishing a functional anal opening.

3. Post-Procedure

Post-procedure care following the surgical repair of a high imperforate anus involves monitoring the patient for any signs of complications, such as infection or issues with the newly created anal opening. Patients may require pain management and should be observed for normal bowel function as they recover. Follow-up appointments are essential to assess healing and ensure that the anal opening is functioning properly. Additional considerations may include dietary modifications to facilitate bowel movements and prevent constipation, as well as education for caregivers on signs of potential complications that may arise after surgery.