Laparoscopic Abdominoperineal Resection: Basic Surgical Steps

What is an abdominoperineal resection?

An abdominoperineal resection is a surgery in which the anus, rectum, and sigmoid colon are removed. This procedure is most often used to treat cancers located very low in the rectum or in the anus.

Once the anus and rectum are removed, a colostomy is created. A colostomy involves bringing a portion of the colon (large bowel) to an opening at the surface of the skin. This new opening, called a stoma, allows waste to pass out of the body. The stoma usually measures from 1 to 1½ inches in diameter. A pouch, or stoma appliance, is worn to collect stool and gas from the colostomy. This pouch is worn at all times since there is no longer conscious control of the elimination of waste products from the body.

Step 1: Once the laparoscopic camera is in the abdomen, the surgeon makes two to five more small incisions. Surgical instruments are inserted through ports placed in these incisions.

Step 2: Preparing the sigmoid colon and rectum for removal

Your surgeon will complete several steps before removing the anus, rectum, and sigmoid colon. First, the main blood vessels that serve the diseased sections of the bowel are divided. Next, the surgeon frees the sigmoid colon and rectum from their attachments to the surrounding structures. The sigmoid colon is then separated from the remaining large intestine.

Step 3: Preparing the anus for removal

After the sigmoid colon and rectum have been prepared for removal, one of the surgeons operates on the area between the legs (perineal region) to cut away the anus. Finally, the anus, rectum, and sigmoid colon are removed from the body.

Step 4: Making the stoma

The surgeon makes the stoma at the site of one of the existing incisions, usually on the left side of the abdomen. First, a small disk of skin is removed from the incision site. The open end of the colon is pulled through the incision to the surface of the skin. The stoma is stitched (sutured) in place. The abdominal cavity is then rinsed out. A small temporary drainage tube is inserted into one of the lower abdominal incision sites. Finally, your surgeon will carefully inspect the abdominal cavity before stitching the incisions closed.

Recovering in the hospital

Hospital stays after a laparoscopic abdominoperineal resection average from 5 to 7 days. You are fitted with a pouch immediately after surgery. However, it takes a few days for your digestive system to become active again, which is signaled by the passage of gas and then stool through the stoma. Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning.While you are recovering in the hospital, your Enterostomal Therapy (ET) nurse will demonstrate how to care for your stoma. You will also receive instructions and be coached through the process of managing your stoma for after your return home.