Consent: Abdominoperineal Resection - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent. Overview of Procedure Abdominoperineal Resections (APRs) are typically performed for very low rectal cancers (or for anal cancers refractory to chemoradiotherapy) or for severe perianal Crohn’s disease APRs have two separate stages to the procedure, with an abdominal approach (either open or laparoscopic) for the rectal dissection and end colostomy formation, and an perineal approach for the excision of the anus and completion of the rectal dissection. The entire specimen, formed of perineal skin, anal sphincters, rectum, and sigmoid colon, can then be extracted. Cancer Research UK, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons Figure 1Schematic demonstrating an abdoperitoneal resection Complications Intra-Operative Complication Description of Complication Potential Ways to Reduce Risk Bleeding Ensure meticulous haemostasis during the procedure; careful dissection at the splenic flexure off the spleen Damage to local structures Structures at risk include small bowel, kidney + bladder + ureter, and ovaries + fallopian tubes + uterus Resection of other structures Local invasion of organs may require further visceral resection, including uterus and bladder Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications Forms part of anaesthetic pre-assessment Early Complication Description of Complication Potential Ways to Reduce Risk Pain Optimal post-operative analgesia, including epidurals or rectus sheath catheters Infection Includes both wound infections and intra-abdominal collections, as well as respiratory or urinary tract infections post-operatively Intravenous antibiotics at induction, minimisation of faecal contamination during procedure, wound irrigation at closure Ileus Minimise contamination and bowel handling, correct any electrolyte abnormalities post-operatively Scarring Use of laparoscopic surgery if possible to result in a smaller abdominal scar Re-Operation Any complication may result in the return to theatre in the immediate post-operative period DVT or PE, Myocardial Infarction, Stroke, or Mortality As with any major surgery, whilst these events are uncommon, important to be aware of Adequate pre-optimisation and anaesthetic assessment, peri-operative prophylactic LMWH, high-dependency level care post-operatively Late Complication Description of complication Potential ways to reduce risk Adhesions Attempt laparoscopic approach if possible, avoid excess tissue disruption Stoma complications Includes stoma retraction, stenosis, or prolapse Incisional hernia, perineal hernia, or parastomal hernia Ensure fascia is closed tightly, using a small bites techniquePlacement of perineal mesh to prevent perineal hernia Sexual dysfunction Damage to pelvic nerves supplying the reproductive organs can be damaged during the rectal dissection, leading to sexual dysfunction Frequent questions What is an abdominoperineal resection (APR)? An abdominoperineal resection (APR) is a surgical procedure performed primarily for very low rectal cancers or anal cancers that do not respond to chemoradiotherapy, as well as for severe perianal Crohn's disease. The operation consists of two stages: an abdominal approach for rectal dissection and colostomy formation, followed by a perineal approach for anus excision. What are the potential complications of an abdominoperineal resection? Complications of an abdominoperineal resection can include bleeding, damage to local structures, infection, and stoma complications. Other risks involve early complications like pain and ileus, as well as late complications such as adhesions and sexual dysfunction. How can the risk of intra-operative complications be minimised during an APR? To minimise intra-operative complications during an APR, meticulous haemostasis should be ensured, and careful dissection should be performed, particularly around the splenic flexure. Additionally, awareness of the surrounding structures, such as the small bowel and reproductive organs, is crucial. What measures can be taken to prevent post-operative infections after an APR? Preventing post-operative infections after an APR can be achieved by administering intravenous antibiotics at the time of induction, minimising faecal contamination during the procedure, and performing wound irrigation at closure. These strategies help reduce the risk of wound infections and intra-abdominal collections. What are the long-term complications associated with an abdominoperineal resection? Long-term complications of an abdominoperineal resection may include stoma-related issues, such as retraction and stenosis, as well as the risk of hernias and sexual dysfunction due to nerve damage. Employing laparoscopic techniques and ensuring proper closure of fascia can help mitigate some of these risks. Rate This Article