Abdominoperineal Resection of the Rectum (APR)

Abdominoperineal resection of the rectum (APR) is an extensive operation that involves removal of the far end (distal) section of the large intestine, including the sigmoid colon, rectum, and anus. The large intestine consists of four sections: the ascending colon, transverse colon, descending colon, and the sigmoid colon, before ending at the rectum.

COMMON SIGNS AND SYMPTOMS

  • In the early stages there often are no symptoms.
  • Blood may be found in the stool by the patient or by the doctor when doing a routine physical examination.
  • The stool may be thinner because it has to squeeze past the cancer.
  • Sometimes the cancer produces the urge to have a bowel movement but nothing comes out.

Once the laparoscopic camera is in the abdomen, the surgeon makes two to five more small incisions. Surgical devices are inserted through ports placed in these incisions.
Step 2: Preparing the sigmoid colon and rectum for removal

Your surgeon will complete several steps before removing the anus, rectum, and sigmoid colon. First, the main blood vessels that provide the diseased sections of the bowel are divided. Next, the surgeon frees the sigmoid colon and rectum from their joints to the surrounding structures. The sigmoid colon is then divided from the remaining large intestine.

Step 3: Preparing the anus for removal

After the sigmoid colon and rectum have been prepared for removal, one of the surgeons operates on the area between the legs (perineal region) to cut away the anus. Finally, the anus, rectum, and sigmoid colon are removed from the body.

Step 4: Making the stoma

The surgeon makes the stoma at the site of one of the existing incisions, usually on the left side of the abdomen. First, a small disk of skin is removed from the incision site. The open end of the colon is pulled through the incision to the surface of the skin. The stoma is stitched (sutured) in place. The abdominal cavity is then rinsed out. A small temporary drainage tube is inserted into one of the lower abdominal incision sites. Finally, your surgeon will carefully examine the abdominal cavity before suturing the incisions closed.

As with all surgery that involve abdominal incisions, moderate to heavy lifting should be avoided until there is satisfactory healing of the operative sites. Until there is satisfactory adjustment of the diet and the individual learns to handle the colostomy, more frequent restroom breaks may be necessary. Development of complications may increase the recovery time.

You will be taken to a recovery room and observed. After your blood pressure, pulse, and breathing are stable, you will be taken to a regular hospital room. You will have a thin plastic tube in your nose for a few days. A catheter will be in your bladder for several days. Pain will be controlled with medicine. After the tube in your nose is removed, you will be started on a liquid diet and advanced to solid food as you tolerate it. As with any operation, complications are always possible. With this type of operation, they can include bleeding, infection, pneumonia, blood clots, and possibly others. You should be able to go home in about 1 week. Arrangements will be made for your medicine, follow-up office visit, and stitch or clip removal. Arrangements will also be made for a home visiting nurse.

A wide variety of recovery tips are available with Dr.K.N.Srikanth MS, FRCS with regard to the laparoscopic procedures.

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