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Abdominoperineal Resection: Symptoms, Classification, Diagnosis & Recovery

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.

  • You will be required to undergo different types of tests and attend a meeting with your specialist to get prepared for APR surgery. Don’t forget to ask every possible question from your doctor.
  • Discuss each and every medicine and supplements which you are taking, it is better to bring them with you to the doctor’s clinic.
  • If you have any kind of allergies from any medicine or general anaesthesia, do not forget to tell your specialist.
  • Your specialist may suggest you some specific medications before AP resection and it is mandatory that you should not take any blood thinning medications at least one week prior to the surgery.
  • On the day of perineal resection, you will be asked not to eat or drink anything after midnight before your surgery.
  • You will be instructed about which medications you should take or avoid before the surgery.
  • The cardiopulmonary risk is assessed and blood is typed and cross-matched before the procedure.
  • You will be prescribed a bowel preparation to clean the stool from your colon and rectum before the APR surgery. There are several types of bowel preparations that may be prescribed, depending on the operation and preference of your surgeon.
  • It is mandatory to follow the bowel preparation prescription strictly as directed.

  • 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 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.

Mrs. Sumi Dinatu Adamu
Mrs. Sumi Dinatu Adamu


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Frequently Asked Questions

Q: What precautions to take after abdominoperineal resection?

A: After the AP resection is done, you will be instructed to care for your colostomy. You should learn how to use appliances and bags needed to control your body waste output.  

After discharge from the hospital, you will be prescribed some pain medication, typically a mild to moderate strength narcotic. Take them as prescribed. You may have some abdominal discomfort or mild nausea for a few days. Therefore, eat slowly and only what is prescribed. Do not forget to drink plenty of liquids.

Q: Will I have pain after APR surgery?

A: Patients are likely to experience some level of pain and soreness after AP resection. However, the duration of pain and discomfort varies from one patient to the other. The surgeon will give you medications to control pain and discomfort. It is important to control pain as you will need to cough and breathe comfortably.

Q:  Will my incision be okay after AP resection?

A: You need to take care of your incisions and wound after the surgery as advised by the surgeon at the time of discharge. You should make a note of specific signs such as redness, swelling, inflammation, warmth, and increased pain and inform your surgeon if you notice any signs of an infection.

Q: What can I bath after perineal resection?

A: You can take a normal bath in the hospital and as soon as you reach home. However, you should refrain from bathing in a bathtub and swimming until your doctor approves of it.

Q: What dietary modifications do I need to make after APR surgery?

A: You will be required to take liquid diet and clear liquids after the surgery. You can slowly shift to solid foods as you adjust to the post-surgery changes. Make sure to follow the guidelines given by your doctor for better recovery.