Abdominal perineal resection (APR): Open technique
- John RT Monson, MD, FRCS, FACS
John RT Monson, MD, FRCS, FACS
- Professor of Surgery
- University of Central Florida, College of Medicine
- Fergal Fleming, MD, FRCS
Fergal Fleming, MD, FRCS
- Assistant Professor of Surgery and Oncology
- Division of Colorectal Surgery
- University of Rochester Medical Center
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.
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 proceduresTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- PREOPERATIVE PREPARATION
- Enterostomal assessment
- Mechanical bowel preparation
- Antibiotic prophylaxis
- Venous thromboembolism prophylaxis
- OPEN SURGICAL TECHNIQUE
- Patient positioning
- Exploration for resectability
- Mobilization of colon
- - Medial to lateral approach
- - Lateral to medial approach
- Mobilization of rectum
- Colostomy construction
- Omental flap
- Repositioning for perineal resection
- - Cylindrical versus conventional approach
- Perineal resection
- INTRAOPERATIVE CHALLENGES
- Ureter and urethra
- Pelvic autonomic nerves
- POSTOPERATIVE MANAGEMENT
- PERINEAL WOUND COMPLICATIONS
- SUMMARY AND RECOMMENDATIONS