Abdominoperineal Resection in Spain

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10

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About the Abdominoperineal Resection

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.

How is Abdominoperineal Resection performed?

  • APR surgery starts with the administration of general anaesthesia. This ensures that patient remains asleep during the perineal resection.
  • Then the surgeon makes a small cut near the belly button and inserts a laparoscope. A laparoscope has a tiny camera on one end. It is inserted through the cut so so that the inside can be seen.
  • Once the laparoscopic camera is in the abdomen, the surgeon makes two to five more small cuts in the abdomen.
  • Surgical instruments are inserted through ports placed on these cuts.
  • The surgeon completes several steps before removing the rectum, anus, and sigmoid colon.
  • The surgeon releases the sigmoid colon and rectum from their attachment to the surrounding structures after dividing the main blood vessels that serve the tumour sections of the bowel.
  • The sigmoid colon is separated from the remaining large intestine after the separation.
  • After the sigmoid colon and rectum are removed, the surgeon operates perineal region to cut away the anus.
  • Finally, the anus, rectum, and sigmoid colon are completely removed from the body.
  • After perineal resection, the surgeon creates the stoma. It is known as a colostomy. The stoma is made from one of the surgical cuts usually placed on the left side of the abdomen.
  • To create a stoma, the surgeon removes a small disk of skin from the area around the cut.
  • The open end of the colon is pulled through the cut on the surface of the skin.
  • The surgeon then stitches the stoma in the place and the abdominal cavity is rinsed out.
  • A small drainage tube is inserted into one of the lower surgical cuts. This drainage tube will promote healing of the tissue inside the abdomen.
  • Finally, the surgeon carefully inspects inside the abdominal cavity and the stitches are used to close the cuts.

Recovery from Abdominoperineal Resection

Recovery of the patient depends on individual circumstances and general health of the patient. A patient may be required to stay in the hospital for three to seven days. However, some patients may need more time to recover.

You can walk and stand on the first day after AP resection and resume most of the usual activities shortly after the surgery. In fact, increased activity reduces the risk of blood clots and also improves breathing. A physical therapist will often visit you during your hospital stay and will help regain your strength after the surgery. After getting discharged from the hospital, avoid lifting more than 5 to 10 pounds for 4 weeks, as this allows the incisions to heal. It also decreases the risk of developing a hernia.

Patient Stories

Frequently Asked Questions

What is the health care infrastructure of Spain / Why should opt for Spain as a destination for your medical treatment?
Spain has a uni payer healthcare system. This means that there is universal coverage for most of the expenses (excluding prescription drugs). One might have to wait for quite some time to avail of elective procedure treatment in Spain. Non-European travelers must have valid health insurance coverage to benefit from the hospitals in Spain. One can also avail of it on a residency visa. The private insurance system helps you to avail the benefits at monthly costs. The taxes in Spain are comparatively lower than those of other European countries. Hence, one can surely opt for this country for medical treatment.
What are the conditions of the hospitals in Spain? Are they JCI certified? What is the quality of the support staff in the hospitals?
The Joint Commission International (JCI) is a global leader in health care accreditation. JCI accreditation is considered a gold standard in worldwide health care. It provides the most skilled and experienced healthcare professionals in the medical industry, as evaluators of the rigorous international standards in healthcare quality and patient safety. Here are a few JCI certified hospitals in Spain :
  • Vithas Xanit International Hospital
  • Grupo Hospitalario Quirónsalud
  • Centro Médico Quironsalud Teknon
  • Hospital General de Catalunya
  • Instituto de Microcirugía Ocular (IMO Barcelona)
  • Sanitas Hospitales
  • Guttmann Institute
  • Instituto Balear de Oftalmología (IBO)
Are the doctors/surgeons in Spain of the best quality?
The hospitals in Spain are based on “el sistema national de salud” which provides high-quality care and medical centres, that is, “centros de salud”. This system has public and private healthcare systems, often within the same level. Since many countries send ex-pats here, one can even find an English speaking doctor very easily. Most doctors are adequately skilled and can handle the cases.
What is the process for obtaining a medical visa in Spain?
One has to apply for a Schengen Visa to gain entry into Spain for a medical purpose. The required documents when applying for a Schengen Visa for Medical Treatment are as follows:
  1. Visa application form.
  2. Two photos.
  3. Valid travel document/passport.
  4. A copy of your passport's data page.
  5. Roundtrip flight reservation.
  6. Travel Medical Insurance.
  7. Proof of accommodation
What support services does MediGence provide in Spain?
MediGence has been praised on a global scale for the list of services they provide. Apart from the listed services, the staff and the guides are adorned for their customer interaction, impromptu assistance, and various other assistance related guidance throughout the tour. Thus, the list of services provided by MediGence are:
  • Insurance query related guidance
  • In-detail guidance till completion of the medical tour
  • Visa Assistance
  • Free airport to hospital transfer
  • On-Ground Support
  • Teleconsultations
  • Accommodations Assistance
  • Rehabilitation and recovery services
Which are the best cities in Spain for medical treatment?
Spain has many cities like Madrid, Barcelona, Valencia, and Pamplona that have some of the best hospitals in Spain. Madrid has good hospitals for general and reproductive health facilities. Barcelona has hospitals specializing in child healthcare.

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