APR surgery: Laparoscopic Abdominoperineal Resection for rectal cancer in simple terms

When your doctor tells you that you need to have an abdominoperineal resection, or APR, you may be feeling a lot of fear and anxiety. You may have many questions in your mind, such as "What kind of surgery is this?", "Will it hurt a lot?", "What will my life be like after the surgery?" It's very normal. So today, let's talk about what this APR surgery is, how to prepare for it, and what happens after the surgery. Knowing these things clearly will help reduce your fear to a great extent.

What exactly is Abdominoperineal Resection (APR) surgery?

Simply put, this involves surgically removing your anus, rectum, and the lower part of your large intestine (sigmoid colon) . The main reason for this surgery is for cancers that develop very low in the rectum, very close to the anus.

In most cases, you may have had several rounds of radiation and/or chemotherapy to control the cancer before this surgery. After the treatments have shrunk the cancer cells, the surgeon will remove the entire area with this surgery.

How should I prepare for the surgery?

Your doctor will guide you carefully to prepare for this. He or she will ask you about your complete medical history. Be sure to tell your doctor about any medications, vitamins, or supplements you are currently taking.

Also, if you have sleep apnea , you should tell us about it. If you use a CPAP machine for it, bring it to the hospital on the day of surgery.

How is the surgery performed?

This surgery is done in a hospital, under general anesthesia. This means that you will not feel anything during the surgery, and you will be completely asleep. The surgery is performed in several main steps.

1. Preparing to remove parts of the intestine

First, the surgeon makes several small incisions through the abdomen (laparoscopy), identifies and cuts the main blood vessels that supply blood to the sections of colon to be removed. Then, the lower part of the colon (sigmoid colon) and rectum are freed from the surrounding tissue. Next, the section to be removed is separated from the remaining healthy part of the colon.

2. Removal of the anus

Next, the surgeon makes another incision in the perineal region and removes the anus. This removes the entire anus, rectum, and colon. The skin over the anus is then sewn shut.

3. Creating a Colostomy

Now you may be wondering, "How will stool pass out after the anus and rectum are removed?" That's why a permanent colostomy is created.

Simply put, this involves bringing a healthy portion of the upper part of your colon to the surface of your abdominal skin and creating a new opening that opens to the outside. This new opening is called a 'stoma' . It is usually a pink opening that is between 1 and 1 ½ inches in size.

Now your body's waste, that is, feces and air, comes out of this stoma. You have to wear a special bag (ostomy pouch) over this. This bag collects the waste. Since you don't have an anus, you no longer have the ability to control the passage of feces. Therefore, you have to wear this bag at all times.

How is the recovery time after surgery?

After the surgery, you will have to stay in the hospital for a few days. An ostomy bag will be placed over your stoma immediately after the surgery. However, it will take a few days for your digestive system to function again. So you will be given liquids to drink at first. As your bowels start to work, you will gradually be introduced to solid foods.

What are the advantages of performing this surgery laparoscopically?

There are several advantages to performing this surgery through a keyhole or laparoscopic method over traditional open surgery.

• The incisions are too small: Instead of one large incision, only a few small incisions are used.
• Reduced pain: The pain felt after surgery is very minimal.
• Reduced bleeding: Less blood is lost from the body during surgery.
• Reduced risk of complications: There is less chance of things like wound infection.
• Faster recovery: The hospital stay is shorter, and you can return to normal life more quickly.

What are the possible complications of this surgery?

Like any surgery, there are some minor risks, but these are not seen very often.

• A perineal hernia can occur where the skin is pulled back after the anus is removed. If necessary, this can be corrected with another surgery.
• Excessive bleeding.
• Problems associated with incisions (wounds festering, non-healing).
• When the wound heals, a small hole in the skin is left (perineal sinus).

If something like this occurs, doctors manage it with treatments such as giving antibiotics or, if necessary, performing minor surgery, depending on its severity.

It usually takes three to six weeks to fully recover from this surgery. However, this time can vary depending on factors such as your overall health. Ask your doctor when you can return to work.

It's normal to feel anxious and worried about having to undergo such a major surgery. So, be open with your doctor about any questions or concerns you may have. Also, if you can join support groups with people who have undergone such surgeries and are now recovering, you will gain a lot of mental strength and courage from their experiences.

APR surgery, Abdominoperineal Resection, rectal cancer, colostomy, stoma, laparoscopy, laparoscopic surgery