Abdomniperieneal resection or APR surgery is a surgical intervention in which the rectum, anus, and sigmoid colon are removed. This is the most commonly used surgical method to address specific GIST tumors, more specifically low rectal cancers, that are located in the lowest parts of the rectum involving the anal sphincters that have not responded to neoadjuvant (preoperative) treatment.
In this article, Dr. Omar Rashid and his expert team will talk about the details of APR surgery and how it can help with cancers that may form in various GI tissues, such as the anal sphincter muscles.
Preparing for APR Surgery
Healthcare providers will assist patients in preparing for abdominoperineal resection or rectum cancer surgery. They will engage in discussions regarding the patient’s medical history and inquire about any prescription medications or supplements they are currently taking. It is crucial for patients to inform their healthcare provider if they have sleep apnea, and if they utilize a CPAP device, they should remember to bring it on the day of the surgery.
In the weeks preceding the surgery, it is recommended that patients refrain from smoking or consuming alcohol. These habits can impede the healing process and potentially lead to serious complications. It is of utmost importance for patients to be truthful with their healthcare providers regarding their smoking and drinking habits. By doing so, they can better assist patients in planning ahead for a successful recovery.
How do Professionals Perform Abdominoperineal Resection Surgery?
Providers usually perform rectum cancer surgery under general anesthesia at hospitals. The steps of APR surgery will include the following:
- Preparing the rectum and the sigmoid colon for removal: Surgeons will perform several tasks before removing the sigmoid colon, rectum, and anus. To get started, they will divide the main blood vessels that serve the cancer-infected sections. After that, they will free the rectum and sigmoid colon and separate the first one from the large intestine.
- Anus removal preparations: The surgeon will then operate on the perineal region the remove the anus. During this, the sigmoid colon, rectum, and anus are all removed, and the skin will be closed where the anus used to be.
- Colostomy: When the rectum and anus are removed, surgeons create a permanent colostomy. This involves bringing the large bowel to an opening on the body, usually the skin’s surface. This is either called the colostomy or stoma, which allows waste to leave the body. These stomas typically measure no more than one to one and a half inches in diameter. Patients will also wear an ostomy bag which will collect the passed stool and gas. These should be worn all the time since patients will no longer be able to control waste elimination.
Typically, APR surgery will take around two to three hours, but the timeframe will always depend on the specific situation at hand and the extent of the disease.
Recovering from Abdominoperineal Resection
After undergoing abdominoperineal resection surgery, most individuals typically remain hospitalized for several days. Immediately following the surgery, patients will be equipped with their ostomy pouches. However, it takes a few days for the digestive system to resume its normal activity. As the intestines begin to function, the patient’s diet will gradually progress from liquids to solid foods.
During your hospital stay, the patient will be provided with instructions from their medical team for postoperative care following APR surgery. These instructions will encompass proper stoma care and guidance on how to change the ostomy bag once they are discharged from the hospital. Colostomy irrigation may be considered as an option to help regulate bowel movements after the procedure.
What Are The Benefits of Laparoscopic Abdominoperineal Resection Surgery?
There is more than one advantage to performing this intervention laparoscopically. When compared to traditional open surgery, this minimally-invasive technique will:
- Require the surgeons to make smaller incisions.
- Reduce pain and discomfort.
- Reduce blood loss during the intervention.
- Reduce the postoperative complication risks associated with the surgery
- Improve recovery and promotes faster healing.
Also, the intervention can be performed robotically as well, where robotic arms hold the medical instruments needed to perform the procedure, which are controlled by the surgeon with the help of a computer console.
What Are the Complications?
In sporadic cases, people can develop a perineal hernia after abdominoperineal resection. This is a weakness where the skin is closed after the anus is removed. This issue can be addressed with surgical hernia repair if necessary. Other abdominoperineal resection complications may include:
- Bleeding.
- Perineal wound problems.
- Perineal sinus (a small hole in the skin).
Treatment for these postoperative complications depends on the severity of the issue. Your healthcare provider may recommend a number of treatments, from antibiotics to corrective surgery.
APR Surgery Outlook
Generally speaking, recovering from abdominoperineal resection surgery takes around three to six weeks. Still, the recovery speed will vary on several factors, such as the patient’s health history and other factors. The type of surgery performed will also play a role, as in the case of laparoscopic abdominoperineal resection, the recovery time can be shorter.
Furthermore, patients will be told by their healthcare provider about the exact time they can safely return to work, school, or their everyday activities. Those who work desk jobs might be able to return to their positions sooner as they will be under less physical stress than those who have active, more demanding jobs.
When Experiencing Worrisome Symptoms After APR Surgery
When should patients call their healthcare provider following the surgery? They should immediately reach out to their healthcare experts if they experience any of the following symptoms:
- Vomiting and nausea
- Pain in the abdomen
- Pain, swelling, or redness where the incisions were made
- Difficulties urinating
- There’s no waste leaving the body in the ostomy pouch for three days
- Fever of 100.5° F or higher
Educate Yourself With the Help of Caring Experts
Without a doubt, when people hear that they need abdominoperineal resection surgery can be especially scary, especially when they research the topic briefly. Those patients who require this surgery as a part of their cancer treatment plan should consult with their provider, where they can voice their concerns and ask essential questions.
A knowledgeable and compassionate healthcare provider understands the massive changes such an intervention will mean for their patients and will do everything in their might to help them adequately prepare for the procedure and give them guidelines for learning to live following the intervention. Apart from giving them the basic guidelines to maximize their patient’s quality of life, providers may also recommend other options, such as joining support groups, to help them cope with the situation better mentally.
As such, if you or a family member are facing a malignancy of this kind and need compassionate support from an expert, don’t hesitate to reach out to our practice. Dr. Rashid is here to help every patient maximize their quality of life, regardless of their diagnosis.