Abdominal Perineal Resection of Rectum
What Is It?
For various reasons the bowel and rectum may be diseased or cancerous and thus may require excision. If you need to have parts of your bowel and rectum removed because of advanced disease, then you need a procedure known as an “abdomino-perineal resection” surgery. Often the disease is near to the opening of the anus and because of this part of the rectum must be removed so you can maintain control of bowel movements.
During this surgery physicians must create a new bowel opening from the wall of the abdomen, hence the name for the complicated surgery. This part of the process is known as a colostomy. Patients are provided with a special bag to collect waste materials.
General anesthesia is administered continuously to all patients undergoing this surgery. A surgeon typically makes an incision roughly 1.5 feet long through the skin and center of the lower abdominal wall. The lower bowel which is diseased must be removed in its entirety. A new opening to relieve wastes is created from the abdominal wall.
The doctor will then close all openings and redress them.
Alternatives to Surgery
Most patients that must undergo this procedure are very ill and have very diseased bowels, and because of this there are not many alternatives to surgery. Bleeding, discharge and pain are often present. Many patients have a blockage in the lower bowel that must be addressed or the patient will experience life-threatening complications. By removing the diseased bowel and rectum, the patient can improve and learn to live a good quality of life.
If the physician were to remove only the bowel the patient would have little or no control of the bowels.
Before The Operation
Doctors will advise patients to prepare for surgery in many ways. If you smoke you will need to stop before surgery. You will need to lose weight if overweight. Blood pressure will need to be controlled. You will also need to arrange for a ride to the hospital. Most doctors will perform several different tests to ensure you are in the best possible health you can be prior to the operation because the recovery is long and requires a lot of energy and resources from your body.
After The Operation
Most patients will need to recover in the hospital for two weeks. A plastic tube s placed in the body to drain the stomach. Many patients find swallowing difficult. Most patients are provided with adequate pain control to ensure they are in the best shape possible. Most patients will also have a catheter placed in their bladder until they are able to get up and move around. This may take a couple of days.
After the first several days following surgery most patients can try eating. Usually within 10 days following surgery stitches are removed from the incision. Drainage tubes are also removed during the first weeks. A nurse will stay with patients to teach them how to change their colostomy bags. Once the dressings are removed the patient can wash and bathe carefully.
Most patients will need to rest several times a day and feel very lethargic for a month, possibly longer following surgery. Many will gradually feel better over the course of several months following surgery.
Some patients will experience nerve damage following surgery; this may extend to the sexual nerves causing problems with erection. There are also complications associated with general anesthesia, although these can be reduced with proper treatment and care. The risk of infection is more likely. It is important patients take good care to avoid infection when possible. Former smokers should avoid smoking until they are completely healed to avoid the potential for infection, as they are more likely to come down with an illness because of their compromised immune systems.
It is also possible to form a blood clot because of the long periods of bed rest following surgery. For this reason it is important to get up and move around as often as possible even if soreness and some discomfort is present. Many patients experience draining from the wounds following surgery when moving, although this is normal albeit uncomfortable or disarming.
Some patients may require additional operations because other parts of the bowel or bladder may become damaged after surgery. Still other complications may include a skin rash, abscess and tissue death surrounding the bowel or near the colostomy site. While these complications are difficult to deal with, they may be necessary to restore the patient to the best possible health. This is not an easy surgery to recover from.
The abdomino-perineal resection surgery is a difficult surgery to undergo and recovery from physically and emotionally. Many patients will take several months to fully recover from this surgery and restore their former energy and stamina. Most patients however once they get over the initial hump can return to normal activities within about three to four months following surgery. Some patients may require rehabilitation or some physical therapy to assist them with this.
It is important patients work with every member of their healthcare team to ensure a proper and adequate recovery. With proper care and communication, complications like infections can be nipped early on to minimize your risk of setbacks.
Estimated Costs for Abdominal Perineal Resection Surgery
The costs of this surgery vary widely depending on the nature of the disease and whether or not the patient develops complications that necessitate an additional surgery. Keep in mind this surgery requires a long period of recovery. If you plan to have your surgery done in another country you will have to establish a medical team to follow up with you in your home country to ensure your proper recovery, unless you plan on spending a great deal of time abroad.