Abdomino-Perineal Resection :
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What is a abdominoperineal resection?
Surgery to remove the anus, the rectum, and part of the sigmoid colon through an incision made in the abdomen. The end of the intestine is attached to an opening in the surface of the abdomen and body waste is collected in a disposable bag outside of the body. This opening is called a colostomy. Lymph nodes that contain cancer may also be removed during this operation.
" Abdomino-Perineal Resection"
Some of the lowest part of your bowel, the rectum, is diseased and has to be taken out. Because the disease is so near to the opening in the back passage, this has to be taken out as well. If the back passage were left in place, you would be unable to control your bowel motions. You might also get complications from the underlying disease. A new opening for the bowel is made in the wall of your tummy. This is called a colostomy. The waste runs into a special stick-on plastic bag.
Conditions for which it is performed
Who Requires Abdominal - Perineal Resection of the Rectum ?
Most patients requiring an abdominal - perineal resection of the rectum procedure have suffered irreparable damage to their bowels by injury or diseases (examples: diverticulitis and colon cancer). Healthcare treatments that rely solely on drugs are not always sufficient at resolving bowel damage, but can be beneficial.
Before the operation
Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to the hospital. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible.. You will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks. You will meet the stoma nurse who will help you through the operation and also afterwards.
Training and experience of Indian doctors is widely acknowledged particularly in the US and UK where they have made significant contributions to the delivery of healthcare in the host countries. Many of these doctors after having specialized and practiced in the West have returned home to set up impressive state of the art facilities with the latest in equipment, technology and service levels particularly in Delhi, Mumbai and Bangalore and to a lesser extent in Ahmedabad, Pune, Hyderabad and Chennai. Abdominoperineal resection in India is, however, far more widely available at large sized towns and cities.
You will have a general anaesthetic, and will be asleep for the whole operation. A cut about 40 cm (15 inches) long is made in the skin and muscle of the central lower part of the tummy wall. The lower bowel within reach is freed from its bed. Another cut is made around the back passage, which is also freed. The whole of the lower bowel is taken out. A fresh opening is made on the side of the tummy wall (usually on the left lower side but sometimes on the right) for the remaining bowel which is made into a colostomy. This looks like a big ‘nipple’ of pink bowel stuck to the skin of the tummy. The wounds are stitched up. You should plan to leave hospital about two weeks after the operation.
An abdominoperineal resection is completed in 4 main steps. These steps are described below.
Step 1 : Positioning the Laparoscope
Once you are asleep, the surgeon will make a small cut (about 1/2 inch) near the bellybutton. A laparoscope will be inserted into the abdomen through this incision. Images taken by the laparoscope will be projected onto video monitors placed near the operating table.
Once the laparoscope is in place, the surgeon will make 4 or 5 more "keyhole" incisions in the abdomen. Surgical instruments will be placed through these incisions to complete the surgery.
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 serve the diseased sections of the bowel will be carefully cut and closed. Next, the surgeon will free the sigmoid colon from its supporting structures and divide it from the remaining large intestine. The rectum will also be freed from its surrounding structures.
Step 3 : Preparing the Anus for Removal
Once the sigmoid colon and rectum have been prepared for removal, one of the surgeons will operate on the area between the legs (perineal region). This operation will allow the surgeon to remove the anus, rectum, and sigmoid colon.
Step 4 : Making the Stoma
Once the anus, rectum, and sigmoid colon have been removed, the surgeon will make the stoma from one of the existing incision sites. The stoma is usually placed on the left side of the abdomen.
First, a small disk of skin will be removed from the incision site. The open end of the descending colon will be pulled through this site to the surface of the skin. (This type of stoma is called an "end colostomy") The stoma will be stitched in place. The abdominal cavity will be rinsed out and a small drainage tube will be inserted into one of the lower abdominal incision sites. This drainage tube will promote healing of the tissue inside your abdomen. Finally, your surgeon will carefully inspect the abdominal cavity and stitch the incisions closed.
Fig : Anal cancer surgery with colostomy. The anus, rectum, and part of the colon are removed, a stoma is created, and a colostomy bag is attached to the stoma.
After The Operation
Most patients will need to recover in the hospital for two weeks. A plastic tube s placed in the body to drain the stomach. Many patients find swallowing difficult. Most patients are provided with adequate pain control to ensure they are in the best shape possible. Most patients will also have a catheter placed in their bladder until they are able to get up and move around. This may take a couple of days.
After the first several days following surgery most patients can try eating. Usually within 10 days following surgery stitches are removed from the incision. Drainage tubes are also removed during the first weeks. A nurse will stay with patients to teach them how to change their colostomy bags. Once the dressings are removed the patient can wash and bathe carefully.
Most patients will need to rest several times a day and feel very lethargic for a month, possibly longer following surgery. Many will gradually feel better over the course of several months following surgery.
What does the operation consist of?
A cut is made in the abdomen and the back passage (anus) and the lower large bowel is removed and a colostomy (stoma) is formed on the abdomen. Body waste will be collected from the stoma in a pouch which will need to be changed on a daily basis.
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