Abdominoperineal Resection- Gastroenterology

During an abdominoperineal resection (APR), the sigmoid colon, rectum, and anus are surgically removed. Rectal cancers occurring very low in the rectum are most frequently treated with this procedure. This surgery often takes place after you have finished your chemotherapy and radiation treatments.

How Is the Surgery Performed?

The procedure is carried out while you are asleep under general anesthesia. Your medical care team will assist you in getting ready for your abdominoperineal resection. In addition, they will inquire about your medical background and go over any prescription medications or dietary supplements you may be taking.

You should also let your doctor know if you have sleep apnea and bring your CPAP machine on the day of surgery if you use one. In addition, you should refrain from smoking and drinking alcohol in the weeks before your procedure.

Surgery for an abdominoperineal resection typically lasts two to three hours. However, depending on your particular situation, this timeframe may change.

An abdominoperineal resection typically involves the following steps:

1. Removing the rectum and sigmoid colon:

The anus, rectum, and sigmoid colon will be removed after several steps are completed by your surgeon. The primary blood vessels that supply the diseased parts of the bowel are first segmented. The sigmoid colon and rectum are then released by your surgeon, who will divide the sigmoid colon from the rest of the large intestine.

2. Removing the anus:

Your surgeon will then operate on the perineal region (the area between the legs) to remove the anus, rectum, and sigmoid colon. Where the anus once was, the skin is stitched shut.

3. Performing a colostomy:

After the anus and rectum have been removed, a permanent colostomy is made. An opening at the skin's surface is created by bringing a section of the colon (large bowel) there. Waste can now exit the body through this new opening, also known as a stoma or colostomy.

The stoma typically has a diameter of 1 to 1 ½ inches. To collect excrement and gas, a pouch or ostomy bag is worn by the patient. Since the body no longer has conscious control over eliminating waste, this pouch must always be worn.

What Are The Benefits Of An Abdominoperineal Resection?

There are two ways abdominoperineal resection can be performed, traditional open surgery and laparoscopic surgery. There are several benefits of the latter, compared to the former, such as:

• Reduced discomfort
• Smaller incisions
• Reduced blood loss throughout the surgery
• Quicker recovery and healing
• Decreased possibility of problems following surgery

What To Expect During An Abdominoperineal Resection?

Most patients stay in the hospital for several days following abdominoperineal resection surgery. After surgery, an ostomy pouch will be fitted for you. However, your digestive system would take a few days to become active again. As your intestines begin to work, you gradually transition from a liquid-only diet to one that includes solid foods.

Your medical team will provide you with postoperative care instructions while you are recovering from abdominoperineal resection. This covers how to change your ostomy bag at home as well as how to care for your stoma properly. After the procedure, colostomy irrigation might be an option to help control bowel movements.

Are There Any Side Effects?

After an abdominoperineal resection, a perineal hernia can occasionally occur. This weakening occurs when the skin is shut after the anus is taken out. If necessary, a surgical hernia repair can solve this problem.

The following are other complications after abdominoperineal resection:

• Bleeding
• Wound issues in the perineum
• Perineal sinus (a small hole in the skin).

The severity of these postoperative problems will determine how they are treated. Antibiotics and corrective surgery are two of the therapies your doctor can suggest.

What Does The Recovery Look Like?

Following an abdominoperineal excision procedure, recuperation typically lasts three to six weeks. However, this time frame may change depending on your medical history, the type of surgery you had, and other circumstances.

Ask your healthcare professional when it is safe for you to resume your regular activities, such as going to work or school. For example, people with desk jobs could return to work sooner than those with jobs requiring a lot of physical effort.

References:

• https://www.ncbi.nlm.nih.gov/books/NBK574568/