Abdominoperineal Resection

ELIGIBILITY

A person who has cancer of the rectum or anus, andis fit for surgery can undergo abdominoperineal resection. The person should not have other medical conditions or factors that may affect the procedure or recovery process. 

In rare case, this surgery is also performed for treating a traumatic injury to the rectum or sigmoid colon. 

PREPARATION BEFORE PROCEDURE

During your first visit to the surgeon, medical history, family history and medication history will be obtained. Before the surgery, some tests like electrocardiography, blood tests, chest X-ray and other tests will be done to plan the procedure. 

Your surgeon may ask you discontinue some medications like painkillers, vitamin supplements or blood-thinning medications a few weeks before the surgery. You will be asked to avoid consuming alcohol or tobacco (in any form). 

You should avoid eating or drinking anything after midnight on the previous day of the surgery. 

Sometimes, a bowel prep may be given to you in order to clean the stool from the colon. 

PROCEDURE TYPE

Based on the patient’s condition and preference, the surgery can be of the following two types: 

• Open surgery (traditional surgery): In this surgery method, along incision is made in the abdomen to reach the surgical site. 
• Laparoscopic surgery (minimally invasive surgery): In this method, several small incisions are made in the abdomen. Then a small camera and surgical instruments are inserted through these incisions to perform the surgery. 

Note: In both the surgical methods, an incision is made in the perineal area, which is the area in between thescrotum and anus (in men) orvagina and anus (in women). 

ABOUT PROCEDURE

The surgery is performed under general anaesthesia. Once the anaesthesia is effective, a breathing tube is placed through the mouth into the windpipe to aid in breathing. A urinary catheter will also be placed to drain urine from the bladder. Based on the type of method, the incision is made in the abdomen and perineal region. 

After getting to the cancer region, the main vessels of the area are divided. Then the sigmoid colon and rectum are detached from the surrounding structures. The sigmoid colon is detached from the large intestine. Then the surgeon will remove the anus through the incision in the perineal region. 

Once the procedure is finished, the portion of the colon is pulled and attached to an opening in the surface of the skin (stoma) at one of the existing incisions (mostly on the left side). This procedure is called as colostomy. The stoma is stitched with the skin. This opening allows the waste to move out of the body. A stoma appliance or pouch is attached to the stoma to collect gas and stool. A small drainage tube is temporarily inserted in one of the incisions at the sitein the abdomen. 

After finishing the procedure, the surgeon will close the incisions by stitches.  

POST-PROCEDURE CARE

The patient is shifted to the post-anaesthesia care unit. The body temperature, pulse, oxygen levels and blood pressure will be checked regularly. A thin tube below the nose or a face mask will be attached to supply oxygen to the patient. Pain medications will be administered by a nerve block, IV medication or epidural catheter. Your digestive system may become active again within a few days. Once the digestive system is active, it starts excreting gases and stool through the stoma. Before you are discharged, your care team will instruct you about how to manage stoma. 

RECOVERY TIPS

Following measures may aid in speedy recovery after abdominoperineal resection:

• Start moving around as soon as possible
• Do lung exercises (to expand the lungs)
• Follow the dietary guidelines 
• Keep the incision dry and clean
• Follow the care instruction for stoma 
• Take prescribed medications on time 
• Drink 8-10 glasses of water daily 
• Avoid lifting heavy weights (more than 10 pounds)
• Do not do any strenuous exercises like jogging or playing tennis
• Avoid playing any contact game like football 
• Do not bend or twistthe body for at least two weeks after the surgery