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An abdominoperineal resection is a surgical procedure for the treatment of colorectal cancer involving removal of the cancerous section of the lower intestine. This procedure is very invasive and often has a significant impact on quality of life for the patient. As a result, physicians will usually pursue other treatment options for the cancer, if possible, before recommending an abdominoperineal resection. The surgery is commonly performed by a general surgeon and may be done at a surgical center specializing in bowel surgery.
In this surgery, the patient's anus, rectum, and lower colon will be removed. Historically, abdominoperineal resections were performed as open surgeries, but many surgical centers now offer a laparoscopic option. This allows surgeons to perform the surgery through a series of small incisions rather than a large open surgical site, cutting down on healing time significantly, as well as reducing the risk of infection and limiting scarring after surgical recovery.
Removal of the lower intestine in an abdominoperineal resection procedure necessitates the installation of a stoma, a hole in the abdomen to allow the patient's wastes to drain. This is connected to a bag to collect waste, as without an anal sphincter, the patient cannot control the release of waste. A colostomy bag can take some time for a patient to adjust to, and many patients experience psychological distress during this adjustment period.
Patients should expect to be hospitalized for around a week after an abdominoperineal resection. During the hospital stay, the patient will be monitored to confirm that the digestive tract is recovering, and will be taught about maintenance of the stoma and the colostomy bag. A trained nurse will remove the bag and clean the area at first, and as the patient recovers, instruction will be provided to allow the patient to manage this aspect of care at home.
Before an abdominoperineal resection is performed, the patient will meet with the surgeon and anesthesiologist to discuss the procedure. The patient's medical history is reviewed for any risk factors and causes of potential concern. Information about recovery times, the goal of the surgery, and aftercare instructions will also be available, and patients may find it helpful to meet with people who have colostomy bags to get an opportunity to talk with them about their experiences. Meeting a fellow patient can make the experience seem less frightening and more manageable, and colostomy patients often have recommendations for management of colostomy equipment that people may find helpful.
@dfoster85 - My uncle is getting ready to have abdominal perineal resection, so it's been on my mind a lot lately! I've actually had laparoscopy in the past (treatment of endometriosis) and it was incredibly easy, but there are indeed risks.
The risks related to a giant wound - bleeding, infection, long recovery - are of course less. But you have to realize that the surgeon is messing about with your insides through a teeny tiny hole, using a miniature camera to see what s/he's doing. It is more awkward for the surgeon than having everything opened up. Because of that, there's a bigger risk of surgical accident, like nicking something that should not be nicked (bowel, blood vessel, etc.).
So there is a somewhat higher risk of that kind of major complication. But if laparoscopy weren't better for most patients on balance, it surely wouldn't be catching on like it i!
Are there any downsides to doing a laparoscopic colon resection as opposed to the open surgery?
I know that any laparoscopic surgery is going to heal more easily because of not having a giant incision. (When I had a C-section, I was told that it was "major abdominal surgery - not like an appendectomy" which I guess requires only a small incision and less messing about with your internal organs. C-section is one of the surgeries they still have to do the old-fashioned way!)
I ask because an acquaintance of mine who is a malpractice attorney was saying that laparoscopy isn't all it's cracked up to be, but I didn't have a chance to ask him to explain. What's the catch?
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