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What is a laparoscopic abdominoperineal resection?
A laparoscopic abdominoperineal resection is a surgery in which the anus,
rectum, and sigmoid colon are removed (figure 1). It is used to treat cancer
located very low in the rectum or in the anus, close to the sphincter (control)
muscles.
(Figure 1 to right: abdominoperineal resection removes the anus, rectum and sigmoid colon
(area shaded in diagonal lines).)
Once the anus and rectum have been removed, a new opening through which waste
can pass from the body will need to be created. This opening, called a
"stoma," is made between the large intestine and the surface of the
skin. It can measure from 1 to 1Ѕ inches around. (This procedure is also called
a "colostomy," for "colon" and "stoma.")
Unlike the anus, the stoma has no sphincter muscles, so you usually cannot
control the exit of waste. You will generally need to wear a pouch (ostomy
collecting device) at all times to collect the waste flow.
You are bound to go through many psychological and physical adjustments after
surgery. It will take time to cope with all of these changes and, at times, you
may feel overwhelmed. Your enterostomal therapist (ET), a nurse specially
trained in the care of the stoma, will explain the stoma to you and provide you
with further resources. Do not hesitate to call your ET nurse after surgery for
further support.
What happens during the surgery?
The term "laparoscopic" refers to a type of surgery called "laparoscopy."
Laparoscopy enables the surgeon to complete the surgery through very small
"keyhole" incisions in the abdomen. A laparoscope, a small,
telescope-like instrument, is placed through an incision near the navel. An
abdominoperineal resection is completed in four main steps. These steps are
described below.
(Figure 2 to right: Laparoscopic surgery is performed through 5 or 6 small incisions in the
abdomen.)
Step 1: Positioning the laparoscope
Once you are asleep, the surgeon will make a small cut (about 1/2 inch)
near the navel. A laparoscope will be inserted into the abdomen through this
incision. Images taken by the laparoscope will be projected onto video monitors
placed near the operating table.
Once the laparoscope is in place, the surgeon will make four or five more
"keyhole" (5-10 mm) incisions in the abdomen (figure 2). Surgical
instruments will be placed through these incisions to complete the procedure.
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 will be carefully cut and closed. Next, the surgeon will
free the sigmoid colon from its supporting structures and divide it from the
remaining large intestine. The rectum will also be freed from its surrounding
structures.
Step 3: Preparing the anus for removal
Once the sigmoid colon and rectum have been prepared for removal, one of
the surgeons will operate on the area between the legs (perineal region). This
operation will allow the surgeon to remove the anus, rectum, and sigmoid colon.
Step 4: Making the stoma
Once the anus, rectum, and sigmoid colon have been removed, the surgeon
will make the stoma from one of the existing incision sites. The stoma is
usually placed on the left side of the abdomen.
First, a small disk of skin will be removed from the incision site. The open
end of the descending colon will be pulled through this site to the surface of
the skin. (This type of stoma is called an "end colostomy.") The stoma
will be stitched (sutured) in place. The abdominal cavity will be rinsed out and
a small drainage tube will be inserted into one of the lower abdominal incision
sites. This drainage tube will promote healing of the tissue inside your
abdomen. Finally, your surgeon will carefully inspect the abdominal cavity and
stitch (suture) the incisions closed.
Recovering in the hospital
Hospital stays after abdominoperineal resection average one week. You will
be fitted with a pouch immediately after surgery. It will take a few days for
your digestive system to become active again. When it does start functioning,
you can begin to drink liquids. As you improve, you can begin eating solid foods
again.
While you are recovering, your ET nurse will change your pouch for you. You
will learn a lot about changing the pouch by watching the ET nurse. You will
also receive instructions and be coached through the process so you can care for
the stoma when you return home.
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