Rectum & Anal Removal Surgery

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Rectum & Anal Removal Surgery

Also known as Abdominoperineal excision of rectum (APR) is a surgical procedure that involves the removal of rectum and anal canal along with the blood supply and associated lymph glands. This procedure is most commonly recommended for cancers of the lower rectum or anal canal. 


It is important to note that after this procedure, the patient will have a permanent colostomy. A colostomy is the cut end of the large bowel (colon) brought to the surface and stitched to the skin through a small cut (stoma) in the tummy. Stools are then passed through the stoma and collected in a bag that sticks to the skin.


What does the entire procedure involve?


This procedure is usually performed under general anaesthesia.

During the procedure, the surgeon will first give the incision in the abdomen and look inside your tummy at the rectum and colon (bowel) and other parts of the abdomen—for example, the liver, stomach, small intestine, as well as uterus and ovaries in women. 

The rectum and part of the large bowel are mobilised (freed up from their surrounding attachments) through the tummy, then the anal canal is mobilised through a cut around the anus so that the diseased segment can be safely removed along with some of the fatty tissue that carries the blood vessels and lymph drainage to the rectum. Special care is taken to avoid damage to neighbouring structures (e.g. Other organs, the tube carrying urine from the kidney to the bladder (ureter), nerves and blood vessels). 

The bowel is then brought out as a colostomy as explained before. At the end of the operation the abdominal wall and the wound around the anus are stitched up and then the skin is closed, usually with absorbable sutures (so there is no need for stitches to be removed after the operation) or with skin clips (which do need to remove at about 10 days after the operation).


Most people who have this type of procedure will need to stay in the hospital for 3-6 days after the operation. After any major surgery, there is a risk of chest infection, wound infection and thrombosis (blood clots).