Overview

 

What Is It ?

Some of the lowest part of your bowel, the rectum, is diseased and has to be taken out. Because the disease is so near to the opening in the back passage, this has to be taken out as well. If the back passage were left in place, you would be unable to control your bowel motions. You might also get complications from the underlying disease. A new opening for the bowel is made in the wall of your tummy. This is called a colostomy. The waste runs into a special stick-on plastic bag.

What Happens During The Surgery ?

The term “laparoscopic” refers to a type of surgery called “laparoscopy.” Laparoscopy enables the surgeon to complete the surgery through very small “keyhole” incisions in the abdomen. A laparoscope, a small, telescope-like instrument, is placed through an incision near the navel. An abdominoperineal resection is completed in four main steps.

These steps are described below:

Step 1: Positioning The Laparoscope

Figure 1: Laparoscopic surgery is performed through 5 or 6 small incisions in the abdomen.

Once you are asleep, the surgeon will make a small cut (about 1/2 inch) near the navel. A laparoscope will be inserted into the abdomen through this incision. Images taken by the laparoscope will be projected onto video monitors placed near the operating table.
Once the laparoscope is in place, the surgeon will make two to four more “keyhole” (5-10 mm) incisions in the abdomen (figure 1). Surgical instruments will be placed through these incisions to complete the procedure.


Step 2: Preparing The Sigmoid Colon And Rectum For Removal

Your surgeon will complete several steps before removing the anus, rectum, and sigmoid colon. First, the main blood vessels that serve the diseased sections of the bowel will be carefully cut and closed. Next, the surgeon will free the sigmoid colon from its supporting structures and divide it from the remaining large intestine. The rectum will also be freed from its surrounding structures.


Step 3: Preparing The Anus For Removal

Once the sigmoid colon and rectum have been prepared for removal, one of the surgeons will operate on the area between the legs (perineal region). This operation will allow the surgeon to remove the anus, rectum, and sigmoid colon.


Step 4: Making The Stoma

Once the anus, rectum, and sigmoid colon have been removed, the surgeon will make the stoma from one of the existing incision sites. The stoma is usually placed on the left side of the abdomen.

First, a small disk of skin will be removed from the incision site. The open end of the descending colon will be pulled through this site to the surface of the skin. (This type of stoma is called an “end colostomy.”) The stoma will be stitched (sutured) in place. The abdominal cavity will be rinsed out and a small drainage tube will be inserted into one of the lower abdominal incision sites. This drainage tube will promote healing of the tissue inside your abdomen. Finally, your surgeon will carefully inspect the abdominal cavity and stitch (suture) the incisions closed.

Possible Complications

As with any operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

This is a major operation and complications can occur more frequently compared with other operations of the bowel. When they happen, they are rapidly recognised and dealt with by surgical staff. If you think that all is not well, please let the doctors or nurses know.
Chest infections may arise, particularly in smokers. Getting out of bed as soon as possible, getting as mobile as possible and co-operating with the physiotherapists to clear the air passages is important to prevent chest infections.

Occasionally the bowel is slow to start working again. This may take a week or more. Your food and water intake will continue through your vein tubing until the bowel works. Sometimes there is some discharge from the drain by the wound. This stops given time.

Wound infection is sometimes seen. This happens relatively more frequently in any bowel operation compared to other 'clean' operations such as taking out your gallbladder and the reason is that the bowel has many bugs that can cause an infection. The infection settles down with antibiotics in a week of two.

Very rarely, during the operation, another part of your bowel, your bladder or a blood vessel can be damaged and this may require another operation to deal with the problem.

Complications related to the colostomy are a skin rash, infection or abscess (a pool of pus) around the colostomy, narrowing/stricture or necrosis (tissue death) of the bowel at or near to the colostomy and also a hernia of the colostomy, a situation where the bowel falls through the skin. These complications occur in approximately 4 to 30% of cases. If you get such complications it is likely that you will need another operation to fix the problem.

Aches and twinges may be felt in the wound for up to six months. Sometimes the lower wound is slow to heal. Sometimes the stoma is troublesome. Sometimes there is some damage to the bladder and sex nerves.

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