Anterior Resection and APR
An anterior resection is the removal of the sigmoid colon and sometimes part of the rectum.
An abdominoperineal resection (APR) is the removal of the sigmoid colon and the rectum, with the creation of a permanent stoma.
After an anterior resection, there may be a slight increase in the frequency of bowel movements. The stool consistency may also become more fluid. After an APR, faecal material will be expelled via the stoma and not through the anus.
An anterior resection is performed in disease states such as colon or rectal cancer, diverticular disease, inflammatory bowel disease or if there is trauma to the large intestine. An APR is usually performed only in certain cases of low rectal cancers.
The procedure is performed under General Anaesthesia, and the patient will need to stay in the hospital for about 3 to 7 days.
In the conventional approach, surgery is performed via a long midline incision on the abdominal wall. An anterior resection or APR can also be performed using laparoscopic surgery, which is otherwise known as keyhole or minimally invasive surgery.
Regardless of the approach, the procedure performed remains the same. In an anterior resection, the affected part of the sigmoid colon and/or rectum is removed, and the cut edges are joined back if it is possible. Some patients may require a stoma formation after this procedure. The stoma is usually temporary. This depends on several factors, which your surgeon will discuss with you.
In an APR, the sigmoid colon, the rectum and anus are removed, and a permanent stoma is created.
Postoperatively, the patient is usually kept fasted overnight, and fluid intake is commenced the following day. The patient is gradually advanced to solid food, depending on the rate of bowel recovery.
There may be tubes left in the abdomen or perineum to remove excess fluid. There will usually be a tube that allows urine to drain out, as it is difficult for the patient to move around the first couple of days after surgery.
The patient will experience wound pain after surgery. This will be controlled by strong pain relief medication. The patient will be encouraged to ambulate as soon as possible, preferably on the day after surgery.
Upon discharge, the patient will be able to take solid food, and is able to ambulate well. If there is a stoma created, the patient and care-givers will be instructed on stoma care and the use of stomal applicances.
The general risks of this operation are:
- Risks of General Anaesthesia
- Heart attack or strain on the heart
- Infection in the lungs
- Infection in the urine
- Wound infection
- Blood clots in the lungs (Pulmonary Embolism)
- Blood clots in the deep veins of the legs (Deep Vein Thrombosis)
The specific risks of this operation are:
- Poor healing or breakdown of the intestine that has been joined together (Anastomotic Leak)
- Pelvic abscess
- Increased bowel frequency