Abdominoperineal Resection

Abdominoperineal Resection (APR) is a surgical treatment for anal cancer and rectal cancer. An APR procedure involves the removal of rectal cancer by eliminating that part of the anus containing cancer. Once the rectum and anus are removed, a colostomy is created by bringing the lower portion of the large bowel (colon) close to the opening of the skin to create a stoma that helps to pass out waste from the body.

There are generally four steps involved in the Abdominoperineal Resection procedure, which includes creating laparoscopic incisions for the surgery, removing the rectum and sigmoid colon, removing the anus with cancer and creating a stoma measuring 1-1.5 inches in diameter. During the surgical procedure, the surrounding tissues and lymph nodes with cancer are removed as well.

Abdominoperineal Resection is done as an elective procedure. It is a big surgery that mostly involves a lot of incisions and removal of the anus, rectum and a large extent of the lower sigmoid colon depending upon the severity of the injury and the disease in the area. Although an elective procedure, an emergency Abdominoperineal Resection surgery may be performed in rare cases of extensive injury to the sigmoid colon and rectum, and perforation in the lower portion of the colon. Patients of Abdominoperineal Resection need to take some important pre-operative preparations to ensure that the surgery go successful.

Before the treatment of Abdominoperineal Resection, these are the preparations to be taken:

• You are advised to take a fibre-rich diet for 3-4 days before the surgery. A few hours before the surgery, you are asked to be on a liquid diet and given laxatives to empty the bowels. You are then put on fasting from the midnight before the surgery.
• It is important to tell your anaesthesiologist or surgeon about your medications. In accordance, you are suggested to stop taking a few medicines, while start taking some new ones.
• You are not allowed to take any blood thinners for at least five days before abdominoperineal operation.
• Consumption of alcoholic drinks is strictly restricted for a while before the surgery.
• Diabetic patients should make sure that their sugar levels stay within a limit. If not, the diabetologist suggests blood sugar controlling medicines, insulin or a combination of oral medicines.
• Normally, patients feel confused and uncomfortable about the information they get regarding Abdominoperineal Resection. Hence, it is advised to get a second opinion from another physician.
• Lastly, the patient is required to sign a consent form agreeing to the Abdominoperineal Resection procedure.

These are a few step-by-step procedures that explain how Abdominoperineal Resection is performed:

Step1: The patient is administered general anaesthesia before the incisions are done. Surgeons use two to five small incisions in the abdomen and insert a laparoscopic camera through one of it.  Other instruments are inserted through the remaining incisions for the operation. Before removing the sigmoid colon, rectum and anus containing cancer, there are a few steps involved.

The surgeon separates the main blood vessel from the diseased bowel. Then, he frees the rectum from the sigmoid colon from the surrounding structures and attachments. The sigmoid colon is finally separated from the large intestine.

Step2: Once the rectum and the sigmoid colon are prepared for removal, the surgeon prepares to cut away the anus. He removes the sigmoid colon, rectum and anus from the body.

Step3: In the final step, the surgeon creates a stoma through a few procedures. He creates the stoma by removing a small layer of the skin by pulling the colon to the surface of the skin. Once, the stoma is stitched in place, the abdominal cavity is cleaned by inserting a drainage tube through one of lower abdominal cuts. He examines the abdominal cavity before closing the incisions.

The hospital stay post Abdominoperineal Resection is 5-7 days. It takes a few more days for your digestive system to function normally that is signalled by the passage of stool and gas. Initially, you are advised to be on liquid diets, and then you are slowly shifted to solid foods. During your stay in the hospital, you are coached and instructed through the process of managing your stoma. Thus, Abdominoperineal Resection recovery time takes some time, but the duration varies from patient to patient.