The patient was brought to the operating room, where after identification and verification of the procedure, general anesthesia was induced and patient placed in modified lithotomy position. The anus was dilated with some difficulty to 2 fingers in size. There is significant anal stenosis, and chronic sphincter tightening was noted. Operating anoscope was inserted, and the posterior mucosa was evaluated. A superficial, fairly large posterior fissure was identified, bleeding slightly because of the dilatation. On the left lateral position (4:00) there is a sizable anal polyp, and just proximal to it a crypt in the mucosa which presents a rather unusual crater-like defect in the mucosa. This is not technically part of the posterior fissure, but needs to be removed, I feel and this would be an adequate site for the lateral sphincterotomy. This lateral site is infiltrated with quarter percent Marcaine solution and elliptical incision was used to excise the proximal polyp and the more distal crypt or mucosal crater described above. Hemostasis was secured with electrocautery and the outer third of the external sphincter was excised with electrocautery, providing a lateral sphincterotomy planned preoperatively. Mucosal edges were reapproximated with running chromic suture, and attention then turned to the posterior fissure. Submucosal tissues again were infiltrated with Marcaine, an elliptical incision is made excising the torn mucosa of the fissure. Mucosal edges were reapproximated with some difficulty because of the irregularity noted here. Finally the endoscope was reinserted and the mucosa examined circumferentially. There is another small polyp sitting atop a moderate internal hemorrhoid at the 8:00 position (right posterior), and this was excised as well bringing a total to 2 polyps in one fissure as the excised tissue specimens. This defect was also closed with chromic suture, and the procedure then terminated. Anoscope was removed and the sphincter tone checked. There is no further stenosis or spasm of the sphincter muscle and hemostasis is adequate. Vaseline gauze dressing is placed in the anus and the patient awakened from his anesthetic having tolerated the procedure well. Estimated blood loss was minimal, and there were no intraoperative complications, and his sensory recovery room in satisfactory condition.
Is the excision of the polyp included in 46200?
Is the excision of the polyp included in 46200?
