Perineal 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.

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

Recovery From an Abdominoperineal Resection

Hospital stays after abdominoperineal resection average 1 week. You will be fitted with a pouch immediately after surgery. It will take a few days for your digestive system to become active again. When it does start functioning, you can begin to drink liquids. As you improve, you can begin eating solid foods again.
While you are recovering, your enterostomal therapist (ET), a nurse specially trained in the care of the stoma, will change your pouch for you. You will learn a lot about changing the pouch by watching the ET nurse. You will also be given instructions and coached through the process so you will be independent when you get home.
You are bound to go through many psychological and physical adjustments after surgery. It will take time to cope with all of these changes and, at times, you may feel overwhelmed. Your ET nurse is a great resource. Do not hesitate to call him or her after surgery for further support.