ABDOMINO-PERINEAL RESECTION

General Information

DEFINITION--Removal of cancerous cells in the rectum and anus through an incision in the lower abdomen and the perineum. Enough of the anus and rectum are removed so that the intestines cannot be reconnected. A colostomy is performed at the same time so that digestive function is not disrupted.

BODY PARTS INVOLVED--Rectum; anus; sigmoid colon; perineum; abdomen.

REASONS FOR SURGERY--Cancer of the rectum or anus.

SURGICAL RISK INCREASES WITH

• Adults over 60.
• Obesity; smoking.
• Poor nutrition.
• Recent illness.
• Alcoholism or other chronic illness.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs.

What To Expect

WHO OPERATES--Proctologist or general surgeon.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: X-rays of lower gastrointestinal tract; blood and urine studies; liver scan; colonoscopy (See Glossary).
• After surgery: Laboratory examination of removed tissue; blood studies.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• An incision is made in the abdomen. The abdominal muscles are divided and the peritoneal cavity is entered. The sigmoid colon is located, isolated and divided. The closer bowel portion is brought to the skin surface for a colostomy.
• The farther bowel portion is closed and placed deep in the pelvis.
• Incisions are made in the perineum.
• The rectum, anus and end of the bowel (intestine) are isolated and cut free of connective tissue.
• Tubes are left in to allow drainage.
• The skin edges of both incisions are closed with sutures or clips, which usually can be removed in 7 to 10 days after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Impotence.
• Surgical-wound infection.
• Adhesions leading to intestinal obstruction.

AVERAGE HOSPITAL STAY--7 to 10 days.

PROBABLE OUTCOME--Expect complete healing without complications. Allow about 3 months for recovery from surgery.

Postoperative Care

† Move and elevate legs often while in bed to decrease the likelihood of deep--

vein blood clots.

• An enterostomy specialist (See Glossary) will teach you how to care for your colostomy.

† You may use non--prescription drugs, such as acetaminophen, for minor pain.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as possible.

• Avoid vigorous exercise for 6 weeks after surgery. Resume driving 1 week after returning home.

DIET--Clear liquid diet until the gastrointestinal tract functions again. Then eat a well--balanced diet to promote healing. Avoid coffee, tea, cocoa, cola drinks, alcoholic beverages and any food or spice that causes painful or unpleasant digestive symptoms. Your doctor may prescribe a special diet.

Call Your Doctor If

Any of the following occur:

• Nausea, vomiting, constipation or abdominal swelling.
• Increased pain, swelling, redness, drainage or bleeding in the surgical areas.
• Signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• New, unexplained symptoms. Drugs used in treatment may produce side effects.