Abdominoperineal resection (APR) is a type of a surgery in which the anus, rectum, and sigmoid colon are removed through small cuts in the belly. It is a surgical procedure done primarily to remove the cancer of the rectum. Typically, abdominoperineal resection (AP) is conducted as an elective procedure. This procedure is most often used to treat rectum cancer if it is located very low in the rectum or in the anus, close to the sphincter muscles.

Nowadays, advanced surgical techniques and other treatment modalities have brought an increase in the rate of sphincter-sparing operations. However, APR surgery is still necessary in selected cases, especially if the patient has distal tumors or poor sphincter function.  AP resection is a major operation. During perineal resection, the rectum, distal colon, and anal sphincter complex are completely removed using both anterior abdominal and perineal incisions. Once the anus and rectum are removed, a permanent colostomy is needed to complete the procedure.

Colostomy brings the colon to an opening at the surface of the skin, which allows the waste to pass out of the body. This new opening is called stoma and usually measures from one to one-and-a-half inches in diameter. A pouch, or a stoma appliance, is needed to be worn at all times. The stoma has no sphincter muscles, so there is no conscious control over the elimination of waste products from the body after the procedure.

The last part of the gastrointestinal system is referred as the colon and it is 5-6 cm long. It is ‘U’ shaped and it starts from the distal part of the small intestine and is connected to the rectum and anus. It absorbs the fluids, processes the metabolic waste products, and eliminates through the rectum and anus. The removal of the colon is called colectomy.

There are different types of colectomies such as complete colectomy,  right hemicolectomy, left hemicolectomy, sigmoid colectomy, and proctocolectomy. The surgical removal of the left side of the colon (descending colon) is called left hemicolectomy surgery. The surgical removal of the cecum, ascending colon, and the hepatic flexure (right side of the colon) is called as the right hemicolectomy surgery.

Some of the conditions that require complete colectomy or hemicolectomy surgery include the following:

• Colon cancer
• Crohn’s disease
• Blockage of the colon
• Precancerous polyps
• Hereditary polyps
• Benign tumours
• Irritable bowel syndrome (IBS)
• Gastrointestinal bleeding
• Bowel twisting and obstruction
• Ulcerative colitis
• Appendicitis with inflammation of the cecum
• Right-side colonic diverticular disease (diverticulosis)

A hemicolectomy procedure can be performed as a laparoscopic or open surgery. The type of the surgery to be performed is decided by the surgeon during the evaluation and the decision depends on the age and the condition of the patient.

Sometimes the laparoscopic procedure can also be turned into open surgery, depending on the feasibility of the procedure with respect to safety and accuracy. Overall, the following parameters decide whether a laparoscopic or an open surgical procedure will be performed:

• Age
• Diagnosis
• Medical history
• Personal preference