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Abdominoperineal resection (AP resection) is a procedure to remove your rectum, anal canal and lower bowel.

It is usually performed when alternative cancer treatments have not been successful.

What happens during abdominoperineal resection?

AP Resection is usually performed under general anaesthetic. In many cases it can be performed laparoscopically (key hole surgery) meaning a shorter hospital stay, quicker recovery and minimal scarring. Your surgeon will advise you on what method they might use. 

During the operation your surgeon will make an incision in your abdomen and your anal canal (back passage). They will remove your rectum (the area where faeces is stored), your lower bowel and your anal canal. 

If your surgery is done laparoscopically your surgeon will make several small incisions in your abdomen. They will insert a laparoscope (a thin tube with a camera attached to the end) in one incision and surgical instruments in the other incisions. Using the laparoscope your surgeon will identify the damaged area of your lower bowel and rectum and remove them. The part of the surgery around your back passage will be done as open surgery.

What is a stoma?

You will need a permanent colostomy (called a stoma) which will mean faeces will empty from your body through an opening in your abdominal wall and into a bag. The anal area will be sutured closed. Small drainage tubes may be inserted in any wounds to prevent fluid buildup.

Before your surgery you will meet with one of our specialist nurses to discuss how the stoma works and show you where it will be on your body. They will also show you a variety of stoma bags and explain how they work. You will not need to wear any special clothing to hide the stoma bag. There are even smaller bags that can be worn very discretely under swimwear. There is no need to change your lifestyle if you have a stoma. Be sure and discuss any concerns you have with our stoma specialist. We understand this is something new and different - and we are here to help.

After your abdominoperineal resection

Following your surgery you will be taken to a recovery area. You may have a drip in your arm to ensure you continue to get the fluids you need. You will so receive medication for pain relief. Please let staff know if you are in any pain. 

You may also have a tube in your nose that goes down the back of your throat to your stomach. This should prevent you from feeling nauseous or vomiting. 

To help you pass urine a tube called a catheter may be inserted into your bladder during your surgery. This will also help us to measure the amount of urine you are passing.

Once you are stable you will be taken to your room.

You may be able to begin eating and drinking soon after your surgery. But if your bowels are slow to move your intake may be restricted. You will be given pain medication but please let us know if you are in any pain.

You will be encouraged to get up and move around soon after your operation. This helps prevent any lung problems and muscle stiffness. 

Our healthcare team will assist you in learning how to look after your stoma so that by the time you go home you will be able to change the stoma bag and care for your stoma yourself.

Going home after abdominoperineal resection

Everyone recovers differently but you will probably go home after five to seven days. Before you leave our healthcare team will advise you on any restrictions. They may also give you advice on diet. You should arrange for someone to drive you home as you will not be able to drive until you can perform an emergency stop.

In the first few weeks of recovery you may feel tired and weak. Rest when you can, but try to move about regularly. Begin regular gentle exercise like walking around the house and build up the distance when you feel confident. 

You should avoid lifting anything heavy and any strenuous activity for the first six weeks of recovery. 

It can take a few months before you begin feeling “normal” again. Any pain can be managed with over the counter pain killers. Be sure and discuss any return to work with your surgeon. You may want to explore a phase return to work with your employer.

What complications can happen?

Every surgical procedure has a risk of complications. Be sure and discuss any concerns you might have about these risks with your surgeon.

General complications of any operation:

  • Pain
  • Bleeding
  • Infection in a surgical wound
  • Blood clots
  • Unsightly scarring
Specific complications of abdominoperineal resection:
  • Hernia
  • Difficulty in passing urine
  • Leak from the bowel join
  • Adhesions (scar tissue)
  • Sexual disturbance

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