Laparoscopic Abdominoperineal Resection

What Is a Laparoscopic Abdominoperineal Resection?

It’s an operation in which a surgeon removes your anus, rectum, and sigmoid colon through small cuts in your belly.

You may need this operation if you have cancer very low in the rectum or in the anus, close to the sphincter muscles that control bowel movements.

Your surgeon will also make a new opening through which waste can pass from your body. Called a stoma, this opening will connect your large intestine to the surface of the skin on your belly. The stoma measures from 1 to 1 1/2 inches around. Your doctor may call this procedure a colostomy.

Unlike your anus, the stoma has no sphincter muscles. So you usually cannot control the exit of waste. You will need to wear a pouch to collect waste.

What Happens During the Surgery?

First, you’ll get general anesthesia, so you’ll be asleep during the operation.

Once you are asleep, the surgeon will make a small cut (about 1/2 inch) near your bellybutton. He’ll insert a tool called a laparoscope, which has a tiny camera on it, through the cut so he can see inside.

Laparoscopic Surgery

Once the laparoscope is in place, the surgeon will make 4 or 5 more small cuts in your abdomen so he can do the surgery.

Preparing the Sigmoid Colon and Rectum for Removal

Your surgeon will complete several steps before removing the anus, rectum, and sigmoid colon. First, he will cut and close main blood vessels that serve the diseased sections of the bowel. Next, the surgeon will free the sigmoid colon from its supporting structures and divide it from the remaining large intestine. And he will also free the rectum from its surrounding structures.

Preparing the Anus for Removal

Once the sigmoid colon and rectum are ready 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.

Making the Stoma

After taking out the anus, rectum, and sigmoid colon, the surgeon will make the stoma from one of the surgical cuts. They’ll usually place it on the left side of the abdomen.

Continued

First, they’ll remove a small disk of skin from the area around the cut. The surgeon will pull the open end of the descending colon through this site to the surface of the skin. (This type of stoma is called an end colostomy.)

The surgeon will stitch the stoma in place, rinse out the abdominal cavity (the area inside you), and insert a small drainage tube into one of the lower surgical cuts. This drainage tube will promote healing of the tissue inside your abdomen. Finally, your surgeon will check inside the abdominal cavity and stitch the surgical cuts.

What to Expect From Recovery

You’ll stay in the hospital for at least several days (the average time is 1 week). Right after surgery, you’ll be fitted with a pouch for your waste.

It will take a few days for your digestive system to become active again. When it does start to work again, you can begin to drink liquids. As you improve, you can move on to solid foods.

While you recover, your “ET” (enterostomal therapist, a nurse specially trained in the care of the stoma) will change your pouch for you. You will learn a lot about how to do this by watching and talking with the ET nurse. You will also get instructions and coaching on the process so you can do it yourself when you get home.

It’s a big adjustment. Give yourself time to feel comfortable with it. Your ET nurse is a great resource for questions and support.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on October 20, 2016

Sources

SOURCES:

Cleveland Clinic.

Perry, W. Clinics in Colon and Rectal Cancer Surgery, August 2007.

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