Laparoscopic Abdominoperineal Resection
What Is a Laparoscopic Abdominoperineal Resection?
A laparoscopic abdominoperineal resection is an operation in which the anus, rectum, and sigmoid colon are removed. It is used to treat cancer located very low in the rectum or in the anus, close to the sphincter muscles (muscles that control bowel movements).
Once the anus and rectum have been removed, a new opening through which waste can pass from the body will need to be created. This opening, called a "stoma," is made from the large intestine to the surface of the skin of the abdomen and can measure from 1 to 1 1/2 inches around. (This procedure may also be called a "colostomy," for "colon" and "stoma.".)
Unlike your anus, the stoma has no sphincter muscles, so you usually cannot control the exit of waste. You will generally need to wear a pouch at all times to collect the waste flow.
What Happens During a Laparoscopic Abdominoperineal Resection?
The term "laparoscopic" refers to a type of surgery called "laparoscopy." Laparoscopy enables the surgeon to complete the surgery through very small "keyhole" incisions in the abdomen. A laparoscope, a small, telescope-like instrument, is placed through an incision near the bellybutton.
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.