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 procedures
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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