Colorectal

Abdominoperineal Resection

ABDOMINOPERINEAL RESECTION (APR)

Indication: Carcinoma of the low rectum or anus invading the sphincter complex, where adequate distal clearance and sphincter preservation are not achievable. Results in a permanent end colostomy.

Patient Position: Lloyd-Davies (lithotomy with Trendelenburg).

Anaesthesia: General.

Prophylactic Antibiotics: Per protocol.

Abdominal Phase:
1. Midline laparotomy (or laparoscopic approach). Abdomen explored.
2. Inferior mesenteric artery ligated close to aorta. Left ureter identified and preserved.
3. Inferior mesenteric vein divided.
4. Sigmoid colon and rectum mobilised. TME performed to the pelvic floor.