CPT® Code 57556

The procedure described by CPT® Code 57556 involves the excision of the cervical stump through a vaginal approach, accompanied by the repair of an enterocele. This surgical intervention is typically indicated for patients who have previously undergone a sub-total hysterectomy and later develop cervical malignancy. The excision process begins with the placement of a tenaculum on the cervix, allowing for a precise incision in the upper aspect of the vaginal mucosa surrounding the cervical stump. The surgeon employs both sharp and blunt dissection techniques to carefully separate the bladder from the cervix and to release any adhesions present. Following the removal of the cervical stump, which includes adjacent parametrial tissue and a portion of the vagina, the excised tissue is sent for frozen section analysis to assess for malignancy. In addition to the cervical stump excision, the procedure includes the repair of an enterocele, which is a type of hernia that occurs when the small intestine bulges into the vaginal canal. The surgical approach involves opening the posterior vaginal mucosa to access the enterocele, excising an ellipse of skin at the junction of the vagina and perineum, and meticulously dissecting the perirectal fascia to expose the enterocele sac. The sac is then incised, allowing the small bowel to be repositioned back into the abdominal cavity, followed by closure of the sac with purse-string sutures. This comprehensive procedure not only addresses the malignancy but also corrects the enterocele, ensuring the integrity of the pelvic floor and vaginal structure.