What is Abdominoperineal Resection?
A surgical procedure to treat anal cancer in which the anus, the rectum, and part of the sigmoid colon are removed through an incision made in the abdomen.
THE PROCEDURE
Once the anus and rectum are removed, a colostomy is created. A colostomy involves bringing a portion of the colon (large bowel) to an opening at the surface of the skin. This new opening, called a stoma, allows waste to pass out of the body. The stoma usually measures from 1 to 1½ inches in diameter. A pouch, or stoma appliance, is worn to collect stool and gas from the colostomy. This pouch is worn at all times since there is no longer conscious control of the elimination of waste products from the body.
Once the laparoscopic camera is in the abdomen, the surgeon makes two to five more small incisions. Surgical instruments are inserted through ports placed in these incisions.
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 are divided. Next, the surgeon frees the sigmoid colon and rectum from their attachments to the surrounding structures. The sigmoid colon is then separated from the remaining large intestine.
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.
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 inspect the abdominal cavity before stitching the incisions closed.
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire, which will allow our doctors to determine your eligibility for Abdominoperineal Resection.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Before your departure your records will be reviewed thoroughly by our surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues.
After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your Abdominoperineal Resection procedure and answer any questions.
Getting your house ready before your surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Day before surgery
You will need to do a bowel prep to clean the stool out of your colon. Your doctor or nurse will give you more instructions based on the type of prep. You should not eat or drink anything after midnight the evening before your surgery.
Morning of surgery
Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.
RECOVERY AFTER SURGERY
When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a few hours, but some will need to stay overnight for observation.
You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
You will have an analgesia pump device to deliver pain medication into your IV or epidural space (in your spine). You will have a catheter in your bladder to monitor the amount of urine you are making. You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk. You will also have 1 or 2 drains in your lower abdomen to drain extra liquid from the area. Most of the time, the drains are removed after a few days. If you will go home with a drain, your nurse will show you how to care for it.
Hospital discharge and home instructions
You are fitted with a pouch immediately after surgery. However, it takes a few days for your digestive system to become active again, which is signaled by the passage of gas and then stool through the stoma.
Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning. While you are recovering in the hospital, your nurse will demonstrate how to care for your stoma. You will also receive instructions and be coached through the process of managing your stoma for after your return home.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
You will be able to leave the hospital when you are:
Most people are able to go home 4-7 days after their surgery.
LIFE AFTER SURGERY
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your doctor’s discharge instructions if they are different from what is listed here.
Your Activity
It is fairly common to feel weak and tired immediately after discharge from the hospital. The body needs time to recover from the stress of a major operation.
Your bowel habits
You may have different bowel habits after your surgery. Loose stools are common for the first week or two after surgery. If you have watery diarrhea, call your surgeon. This may be a sign of a bowel infection. Severe constipation should be avoided. See the section below on medicines for constipation.
Your diet
There are generally no dietary restrictions following surgery. Avoid foods that cause diarrhea or digestive discomfort. You will eventually be able to resume your regular diet. A dietary supplement or drink can be used.
Medications
Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.
For pain
Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.
For constipation
Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.
Call your surgeon right away if you have:
FOLLOW-UP
Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.