CPT® Code 57300

The procedure described by CPT® Code 57300 involves the surgical closure of a rectovaginal fistula, which is an abnormal connection between the rectum and the vagina. This condition can be either congenital, meaning present at birth, or acquired due to various factors. Acquired rectovaginal fistulas may arise from infections, traumatic injuries to the perineum during childbirth, complications following surgical procedures involving the vagina or rectum, or as a result of radiation therapy for cancer treatment. The closure can be performed using either a vaginal or transanal approach, depending on the specific circumstances and anatomy of the patient. In the vaginal approach, the surgeon elevates the vaginal mucosa surrounding the fistula to expose it, followed by the placement of purse-string sutures to invert the fistula into the rectal lumen, ultimately closing the vaginal mucosa. Conversely, the transanal approach utilizes an anoscope to locate the fistula, where an advancement flap of mucosal and submucosal tissue is created, and in some cases, muscle tissue is also involved. The procedure includes debriding the fistula tract, suturing the muscle tissue over the fistula, excising the tip of the fistula in the rectum, and advancing the flap to cover the closed fistula tract, while leaving the vaginal side of the fistula open. This detailed surgical intervention aims to restore normal anatomy and function, alleviating the complications associated with rectovaginal fistulas.