General Surgery · Colorectal

Abdominoperineal Resection (Open) - Version 2

OPERATION: Abdominoperineal Resection (APR) (Open)
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: IV broad-spectrum antibiotics at induction including anaerobic cover
POSITION: Lloyd-Davies / dorsal lithotomy — simultaneous abdominal and perineal access. Correct stoma site scratched with 18-gauge needle pre-operatively. Anal verge sewn shut with heavy silk purse-string pre-operatively.

INDICATION:
Rectal carcinoma with sphincter involvement precluding sphincter preservation [/ anal canal carcinoma failing chemoradiotherapy / persistent/recurrent anal canal carcinoma / anorectal Crohn's disease with uncontrolled septic complications]. Preoperative assessment: colonoscopy, EUS [T/N stage], CT/MRI staging. [Ureteric catheters if hydronephrosis or expected difficult pelvic dissection]. Pre-operative stoma marking by enterostomal therapist. [Neoadjuvant chemoradiotherapy completed]. Type and crossmatch and VTE prophylaxis.

PROCEDURE: