Laparoscopic abdominoperineal resection
Depending on how far bowel cancer has spread, an operation to remove the anus, rectum and part of the large bowel may be recommended. This procedure may be carried out using keyhole surgery and is called a laparoscopic abdominoperineal resection – sometime shortened to AP resection.
The operation involves having a colostomy, where part of the bowel opens out on to the abdominal surface. This opening is called a stoma and through it waste is then collected in a special bag which has to be worn at all times. The implications of this – and how it works – will be explained before the procedure goes ahead.
The procedure is done under general anaesthetic. In some cases, keyhole surgery will not be possible and an 'open' operation will be carried out, with longer recovery times.
If keyhole surgery is performed, then small incisions are made in the abdomen. The main instrument is the laparoscope – a thin tubular device with a camera feeding a video monitor.
Other surgical instruments are passed through other incisions.
The damaged parts of the lower bowel and rectum are identified and the operation to remove them begins.
An incision is also made in the back passage (anal canal) using open surgery so that the parts being removed can be taken out.
Checks will be carried out for bleeding and other possible problems before the incisions are closed up.
Drainage tubes from the incision wounds may be inserted as well as a catheter for urine.
After waking up in the hospital's recovery room, pain relief will be given.
After recovery, instructions will be given on use of the colostomy bag.
Before being discharged from hospital, aftercare instructions will be given and follow-up appointments will be arranged.
Details will be given of when it is safe to resume various activities. Information will also be given on wound care, and what to do in the event of any problems or concerns.
Possible risks from the procedure will have been explained beforehand, and include:
- Blood clots
- Problems urinating
- Leaking bowel
- Internal scar tissue adhesions
- Sex problems.