You or someone you know may have felt a little scared and nervous when the doctor mentioned a surgery called 'Proctectomy'. That's very normal. Who doesn't like the idea of surgery, right? But if we know these things clearly and precisely, we can eliminate unnecessary fear and face it with peace of mind. So today, let's talk about this Proctectomy surgery in simple terms.
Simply put, what is Proctectomy?
A proctectomy is a surgical procedure that removes part or all of your rectum. Now you may be wondering what the rectum is. It is the last part of your large intestine, about six inches long. More specifically, it is the part just above the anus, where stool comes out. In some cases, depending on the condition, the rectum may also have to be removed during this surgery.
Why do you need to have this kind of surgery?
There are several main reasons for performing such a major surgery. A doctor will only recommend this surgery in extreme cases, when there is no other option.
- Rectal cancer: This is the main and most common reason for a proctectomy. This surgery is necessary to remove cancer cells and stop them from spreading.
- Inflammatory Bowel Disease (IBD): You may have heard of ulcerative colitis or Crohn's disease . When these become too severe to be controlled with medication and other treatments, surgery may be necessary to relieve the pain and diarrhea that they cause.
- Familial Adenomatous Polyposis (FAP): This is a genetic condition. It causes a large number of small growths (polyps) to form in the colon and rectum. These growths have a high chance of becoming cancerous over time. So this surgery is recommended as a step to prevent cancer from developing.
Although this surgery is major, the help it provides to save you from a life-threatening illness like cancer is priceless.
How do you prepare before surgery?
Your doctor will perform a complete examination of you before surgery. It is important to have a good understanding of your overall health before planning your surgery.
- Tests: Blood tests, ECG tests, and other imaging tests if necessary. If you haven't had a colonoscopy before, you will need to have that done as well.
- Bowel prep: This is very important.Before the surgery, the intestines must be completely empty and clean. For this, the doctor will prescribe a laxative ( laxative ) or use an enema .
- Medications: If you are taking any medications, such as blood thinners, you will be asked to stop taking them a few days before surgery. Be sure to tell your doctor about all medications you are taking.
- Smoking: If you are a smoker, quitting completely a few weeks before surgery will greatly help the healing process.
How the surgery is performed and the main types
Before the surgery begins, an anesthesiologist will give you general anesthesia. So you will be asleep throughout the surgery without feeling any pain.
The type of proctectomy you undergo depends on the nature, location, and extent of the disease. There are three main types.
| Type of Surgery | Description |
|---|---|
| Abdominoperineal resection (APR) | In this, your entire rectum, anus, and the muscles around it (sphincter muscles) are removed. Because the anus is removed, an opening is made in the skin of the abdomen to allow stool to pass through. This is called an ostomy . A pouch is attached to the outside of the opening. Stool collects in this pouch. This pouch needs to be emptied several times a day. This surgery is done if the cancer is very close to the anus. |
| Low anterior resection (LAR) | This involves trying to preserve the anus and muscles as much as possible. Only the diseased part is removed, and the remaining healthy part of the intestine is reconnected to the anus ( anastomosis ). If this is successful, an ostomy bag is not needed. You can pass stool normally. |
| Robotic-assisted rectal resection | This is a modern, minimally invasive method used to perform LAR surgery. The surgeon uses robotic technology to perform the surgery with great precision and precision. The advantages of this are reduced bleeding, faster recovery, and greater accuracy. |
What happens after the surgery?
After the surgery, you will need to stay in the hospital for a few days, maybe a week, depending on your condition.
- Pain management: You will continue to receive medication to control the pain you are experiencing.
- Tubes: A catheter may be placed to drain urine and other tubes (drains) may be placed to remove fluid that collects at the surgical site. These are temporary.
- Food: You may not be able to eat at first. As your digestive system recovers, you will be given liquids first, and then gradually introduced to a soft diet.
- Physical therapy: A physical therapist can help you regain strength and walk.
Before you go home, your medical team will explain how to care for your wound, how to take pain medication, what foods to eat, and any instructions you need to follow.
What are the risks and complications of the surgery?
Like any major surgery, proctectomy surgery can have certain risks and complications, and it's important to be aware of them.
| Complication Type | Description |
|---|---|
| Short-term Complications | |
| Infection | Infections can occur at the incision site or inside the abdomen. |
| Bleeding | If you bleed excessively during or after surgery, you may need to have a blood transfusion. |
| Blood clots | After surgery, blood clots can form in the legs due to increased standing. If they travel to the lungs ( pulmonary embolism ), they are dangerous. |
| Leakage in the connection | If a leak occurs at the site of the intestinal reconnection (anastomosis), surgery will have to be performed again. |
| Long-term Complications | |
| Sexual dysfunction | The surgery can damage the nerves involved in sexual function, which can cause erectile dysfunction in men or anorgasmia in both sexes. |
| Changes in bowel movements | You may experience frequent urges to go to the bathroom, sudden urges to go to the bathroom, or perhaps difficulty controlling your bowels. |
| Ostomy-related problems | Conditions such as skin problems, leaks, or hernias can occur around the ostomy bag. |
When do you need to talk to the doctor?
Once you get home, it's important to be aware of certain warning signs. If you notice any of these, call your doctor immediately.
- If you have a fever of 38 degrees Celsius (100.4 Fahrenheit) or higher.
- If the pain is getting worse or is not relieved by painkillers.
- If the incision site is red, swollen, or pus-like fluid is coming out.
- If there is excessive bleeding.
- If you have difficulty urinating or if urine does not come out at all.
- Persistent nausea and vomiting.
- Difficulty breathing.
- If you notice a change in the function of the ostomy bag (color, size).
Take-Home Message
- A proctectomy is a major surgery, but it is a necessary procedure that can save your life from a disease like cancer or provide you with relief from a serious medical condition.
- It is very important to follow the doctor's instructions exactly before surgery to achieve a successful outcome.
- It takes time to heal. During that time, be patient, follow medical advice, and have the support of your family.
- It is your right to talk openly with your doctor about any questions or concerns you may have.
- With modern surgical technology, the results of these surgeries are very successful. So, face this with a positive mindset.
👩🏽⚕️ Frequently Asked Questions (FAQ) from the Doctor
💬 What is proctectomy surgery?
Proctectomy is the surgical removal of part or all of the rectum, which is the last part of the large intestine.
💬 Why is a proctectomy performed?
There are several main reasons for this surgery, including rectal cancer, severe inflammatory bowel disease (IBD) that cannot be controlled with medication, and genetic conditions such as Familial Adenomatous Polyposis (FAP), which is used to prevent the development of cancer.
💬 Is proctectomy surgery performed for rectal cancer?
Yes, the main and most common reason for a proctectomy is rectal cancer. This surgery is very important to remove cancer cells and stop them from spreading to other parts of the body.
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