Part of the TeachMe Series

Consent: Anterior Resection

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Last updated: December 12, 2021
Revisions: 2

Last updated: December 12, 2021
Revisions: 2

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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

An anterior resection is an operation to remove the rectum and sigmoid colon, in almost all cases performed due to a sigmoid or rectal cancer. The majority of procedures are done electively, ideally laparoscopically, though emergency open cases may be needed in cases of perforation.

Anterior resections can be classified as standard anterior resections (sometimes known as “high” anterior resections), low anterior resections, and ultra-low anterior resections, on the exact location of the tumour in the rectum, relative to the peritoneal reflection and the anal sphincter complex.

High anterior resections can usually be safely anastomosed with a circular stapler device, not necessarily requiring a defunctioning ileostomy. However, in low and ultra-low anterior resections, the dissection is often difficult and the anastomosis more challenging, therefore a defunctioning ileostomy is often formed to limit the damaging sequela of any anastomotic leak that may occur.

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 Pain is often worse in open procedures, compared to laparoscopic 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
Anastomotic leak Good blood supply at the anastomosis, bowel not under tension
Ileus Minimise contamination and bowel handling, correct any electrolyte abnormalities post-operatively
Scarring Use of laparoscopic surgery if possible to result in a smaller 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, prolapse, or high stoma output, if a stoma is formed
Incisional hernia Ensure fascia is closed tightly, using a small bites technique
Sexual dysfunction Damage to pelvic nerves supplying the reproductive organs can be damaged during the rectal dissection, leading to sexual dysfunction
Low anterior resection syndrome Following the procedure, patients can report symptoms of faecal incontinence, frequency, urgency, or feelings of incomplete emptying

 

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