Laparoscopic Abdominoperineal Resection

Overview

An abdominoperineal resection (APR) is a surgical procedure that entails the removal of the anus, rectum, and sigmoid colon. This surgery is frequently employed to treat rectal cancers that are located in the lower region of the rectum. Typically, it is carried out after radiation and/or chemotherapy treatments have been administered.

Risks

Occasionally, individuals may experience the development of a perineal hernia following abdominoperineal resection. This condition involves a weakness in the area where the skin is closed after the removal of the anus. If required, surgical hernia repair can be undertaken to address this condition. Additional complications associated with abdominoperineal resection comprise:

• Issues with the perineal wound
• A tiny skin hole (perineal sinus)
• Bleeding

The approach to addressing these postoperative complications is contingent upon the severity of the problem. Your doctor might suggest various treatments, ranging from the use of antibiotics to corrective surgical procedures.

Before the procedure

Your doctor plays a vital role in preparing you for your abdominoperineal resection surgery. They will thoroughly review your medical history and discuss any medications or supplements you are currently taking. If you have sleep apnea, it is crucial to inform your doctor about it. Additionally, if you rely on a Continuous Positive Airway Pressure (CPAP) device, make sure to bring it with you on the day of your surgery.

In the weeks leading up to your surgery, it is strongly recommended to refrain from smoking or consuming alcohol. Both of these habits can hinder the healing process and pose serious risks to your recovery. It is of utmost importance to have an open and honest conversation with your doctor regarding your smoking and drinking habits, as they can provide guidance and support to ensure a successful recovery.

During the procedure

This surgery is conducted under general anesthesia within a hospital setting. The steps of abdominoperineal resection comprise:

• Preparation for the removal of the sigmoid colon and rectum: Prior to the removal of the anus, rectum, and sigmoid colon, your surgeon will undertake several procedures. Initially, the main blood vessels supplying the affected areas of the bowel are severed. Subsequently, the surgeon releases the sigmoid colon and rectum, followed by the separation of the sigmoid colon from the rest of the large intestine.
• Preparation for the removal of the anus: Following the previous steps, your surgeon proceeds to operate on the perineal region, to extract the anus. The anus, along with the rectum and sigmoid colon, is then removed from the body. The surgical site is sutured to close the area where the anus was originally situated.
• Performing a colostomy: Following the removal of the anus and rectum, a permanent colostomy is made. This procedure entails bringing a segment of the colon (large bowel) to the surface of the skin, creating a new opening known as a stoma or colostomy. The stoma, typically measuring between 1 to 1½ inches in diameter, serves as an exit for waste to leave the body. To manage the elimination of gas and stool, an ostomy bag, also referred to as a pouch, is worn continuously since conscious control over waste elimination is no longer possible.

Typically, the abdominoperineal resection surgery lasts approximately two to three hours. However, the duration may vary based on individual circumstances.

After the procedure

After undergoing abdominoperineal resection surgery, individuals generally remain hospitalized for several days. Following the surgery, you’ll be provided with an ostomy pouch. It takes a few days for your digestive system to regain activity. The reintroduction of your diet progresses gradually, transitioning from liquids to solid foods as your intestines resume normal functioning.

During your hospital recovery, your doctor will provide guidance on postoperative care following abdominoperineal resection. This encompasses instructions on the appropriate care for your stoma and the proper procedure for changing your ostomy bag once you are back home. Colostomy irrigation may be an option to assist in regulating bowel movements following the procedure.

Outcome

Recovery following an abdominoperineal resection surgery typically spans a range of three to six weeks. This duration can fluctuate based on various factors, such as your medical history, the specific surgical procedure undertaken, and individual circumstances.

It is advisable to consult your healthcare provider to determine the appropriate time for you to resume school, work, or other activities. People with desk jobs may find it feasible to return earlier than those with physically demanding occupations.

If you have undergone an abdominoperineal resection, it is crucial to promptly contact your healthcare provider if any concerning symptoms manifest. These symptoms may encompass:

• Abdominal discomfort or pain.
• Episodes of nausea and vomiting.
• Any signs of redness, swelling, or pain at the incision sites.
• Absence of waste in your ostomy pouch for a consecutive period of three days.
• A body temperature reaching 100.5°F or higher.
• Difficulty with urination.

For any questions or concerns about your post-surgery condition, always consult with your healthcare team.