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Abdominal perineal resection (APR): Open technique

Topic Outline

GRAPHICS

INTRODUCTION

An abdominal perineal resection (APR) includes the resection of the sigmoid colon, rectum, and anus (figure 1), and the construction of a permanent end colostomy.

INDICATIONS

Benign and malignant conditions that can be treated by APR include, but are not limited to:

  • Crohn’s proctitis with anal disease
  • Ulcerative colitis, not a candidate or amenable to an ileal pouch anal anastomosis
  • Fecal incontinence, not amenable to sphincter sparing procedures
  • Low lying rectal cancer involving anal sphincter complex and/or positive distal margin
  • Anal cancer, failed neoadjuvant therapy
  • Anal cancer, recurrent
  • Anal melanoma

PREOPERATIVE PREPARATION

Enterostomal assessment — Preoperative counseling and education with a skilled enterostomal nurse therapist and site selection for optimal placement of the ostomy are the key components of preoperative preparation. (See "Surgical principles of ostomy construction", section on 'Preoperative preparations'.)

Mechanical bowel preparation — A mechanical bowel preparation (MBP) is not included in preoperative preparation. A review of the evidence to omit a MBP is discussed separately. The use of mechanical bowel preparation (MBP) prior to colon and rectal surgery is controversial. (See "Surgical oncologic principles for the resection of colon cancer", section on 'Bowel preparation'.)

                    

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Literature review current through: Aug 2014. | This topic last updated: Aug 30, 2012.
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