Repair of anorectal fistula with plug (eg, porcine small intestine submucosa [SIS])
CPT4 code
Name of the Procedure:
Repair of Anorectal Fistula with Plug (e.g., Porcine Small Intestine Submucosa [SIS])
Summary
This procedure involves the surgical repair of an anorectal fistula using a plug made from porcine small intestine submucosa (SIS). The plug helps to close the abnormal connection between the rectum or anus and the skin.
Purpose
The procedure addresses the issue of an anorectal fistula, which is an abnormal connection between the rectum or anus and the surrounding skin. The goal is to close this connection to prevent infection, reduce discomfort, and promote healing.
Indications
Patients experiencing recurrent infections, drainage, discomfort, or abscesses in the anorectal area may be candidates for this procedure. It is typically indicated for those who have not responded well to less invasive treatments.
Preparation
Patients may be instructed to fast for a certain period before the procedure and may need to adjust their medication regimen. Preoperative assessments may include blood tests, imaging studies, or a thorough physical exam.
Procedure Description
- Anesthesia is administered to ensure the patient is comfortable, typically regional or general anesthesia.
- The surgeon makes an incision to access the fistula tract.
- The fistula is cleaned and any infected tissue is removed.
- The SIS plug is placed in the fistula tract to block it.
- The area is sutured, and the surgical wound is dressed.
The procedure utilizes specialized surgical tools, including the SIS plug, sutures, and possibly endoscopic instruments for visualization.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
The procedure is usually performed in a hospital or a surgical center.
Personnel
The team includes a colorectal surgeon, anesthesiologist, surgical nurses, and possibly a surgical technician.
Risks and Complications
Common risks include infection, bleeding, and pain at the surgical site. Rare complications may include allergic reactions to anesthesia, improper healing of the fistula, or recurrence of the fistula.
Benefits
The expected benefits include the closure of the fistula, reduced infections, and improved comfort. Benefits are usually realized within a few weeks post-surgery.
Recovery
Patients might need to stay in the hospital for a brief period post-surgery. Postoperative care includes keeping the area clean, managing pain with medications, and attending follow-up appointments. Recovery time may vary, often ranging from a few weeks to a couple of months.
Alternatives
Other treatment options include fistulotomy, seton placement, fibrin glue, and advancement flap procedures. Each alternative has its own pros and cons related to healing time, invasiveness, and success rates.
Patient Experience
During the procedure, the patient will be under anesthesia and should not feel pain. Afterward, there may be discomfort, which can be managed with pain medications. Patients are advised to follow a specific diet and hygiene regimen to promote healing and avoid complications.