Abdominoperineal excision of rectum (APER)
Preparation:
This procedure is usually performed for patients with rectal cancer and as such much of the preparation will relate to identifying the cancer and thereafter determining it’s extent. Depending upon the exact situation a course of radiotherapy may have be required before surgery. The specific pre-operative preparation is as for a colostomy. Thereafter the preparation is standard for a general anaesthetic.
Procedure:
Traditionally this operation was performed through an abdominal incision. Through this the left side of the colon was freed and the rectum freed from surrounding attachments as far as the pelvic floor. Thereafter the anus and lower part of the rectum were removed from below by cutting, from the perineum, around the anus and deepening the cut until the dissection from inside the abdomen was encountered. The rectum is then removed and the end of the bowel brought onto the surface as a colostomy. This is usually sited in the lower left side of the abdomen
Recently we have tended to perform the abdominal part of this operation using “keyhole” or laparoscopic techniques. Using this technique there is no large abdominal incision but instead 4 small incisions through which instruments are inserted. There is still a cut around the anus and a colostomy but recovery is generally quicker and post operative pain less as there is no large cut in the abdomen
Anaesthetic:
General
Post Op:
Initial care concentrates on providing adequate pain control and ensuring that recovery is proceeding as planned. Over the next few days there will be a gradual return to normal for the bowel which will not have been working – as this happens oral fluids and diet are re-introduced. A catheter will have been placed in the bladder at the time of the surgery and as mobility increases this can be removed. Patients will also be taught how to manage their colostomy.
Follow-up care will be determined by the underlying disease process (i.e. rectal or anal cancer)
OPC Code:
