# Anal advancement flap for anal fissure



## SaraB126 (Apr 17, 2013)

Does anyone know which CPT code I should use for this procedure? Thank you!



PREOP DX:  Anal fissure
POSTOP DX: same

PROCEDURE:  Anal advancement flap


FINDINGS: an anterior skin tag noted, with a fissure to either side of the tag. There was also a posterior anal fissure. The sphincter muscle was not tight, and I was easily able to place four fingers in the anal canal.  The perianal skin was extremely excoriated in a circumferential ring.  Given the symptoms, the decision was made to perform an anal advancement flap (external to internal), thereby covering the largest fissure right anterior to midline, hopefully opening up the anal canal.  The other factor will be aggressive perianal hygiene.  


OPERATION IN DETAIL: The patient was taken to the operating room and underwent general anesthesia.  Patient was sterilely prepped and draped in the high lithotomy position.  Perianal block was performed by injecting 10ml local anesthetic in the intersphincteric groove both right and left lateral.
            The above findings were noted. A diamond shape flap was created proximal to the fissure that was 8 mm on each size.  The diamond was mobilized sharply, and advanced into the anal canal, thereby covering the anterior anal fissure.  The flap was secured with a series of interrupted 3-0 chromic sutures.  Hemostasis checked and noted to be excellent.   Nupricainal cream placed in the anal canal


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## nsteinhauser (Apr 18, 2013)

46999... unless someone out there has found an appropriate listed code?


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