CPT® Code 45108

1. Indications

The anorectal myomectomy procedure is indicated for the following conditions:

• Hirschsprung's disease - A developmental disorder characterized by the absence of ganglion cells in the distal colon, leading to functional bowel obstruction.

2. Procedure

The anorectal myomectomy involves several critical procedural steps to ensure effective treatment.

• Dilation of the anus - The procedure begins with the careful dilation of the anus using narrow retractors. This step is essential to provide adequate access to the surgical site and facilitate the subsequent incision.
• Incision in the anal mucosa - A transverse incision is made in the posterior wall of the anal mucosa, positioned just above the mucocutaneous junction. This incision is crucial for accessing the underlying muscularis layer and allows for the necessary surgical intervention.
• Elevation of the mucosa - Following the incision, the mucosa is elevated to expose the muscularis layer beneath. This elevation is vital for the excision process and ensures that the surgical field is clear for the next steps.
• Excision of muscularis and internal sphincter - A strip of the muscularis, measuring between 6 to 10 centimeters, is excised along with a portion of the internal sphincter. This excision is the core of the procedure, aimed at alleviating the obstruction caused by Hirschsprung's disease.
• Closure of the mucosa - After the excision, the overlying mucosa is closed meticulously. This closure is often performed over a small drain, which helps manage any potential fluid accumulation post-surgery.

3. Post-Procedure

Post-procedure care following an anorectal myomectomy typically involves monitoring for any complications, managing pain, and ensuring proper healing of the surgical site. Patients may require follow-up visits to assess recovery and bowel function. The presence of a drain may necessitate additional care to prevent infection and facilitate drainage. It is essential for healthcare providers to provide clear instructions regarding activity restrictions and signs of potential complications that patients should watch for during their recovery period.