Proctectomy, Laparoscopic

Proctectomy is a surgical operation to remove the rectum, often as a result of cancer. If you have been diagnosed with rectal cancer, your treatment will depend on how far along your cancer is, as well as other factors. But for most people with rectal cancer, some type of proctectomy procedure will be needed. It may also be used to treat inflammatory bowel disease.

Procedure overview

Proctectomy can be done in several ways. The type that you and your surgeon choose will depend on factors such as the location of your cancer and how deeply your cancer has spread. Your large intestine, also called your colon, is the last part of your digestive system. The last six inches of your colon are your rectum and anal area. Proctectomy may remove all or part of the rectum and may include the anal opening in some cases.

Reasons for the procedure

The most common reason for proctectomy is rectal cancer, which makes up about 30 percent of all cancers of the colon. After your doctors have diagnosed rectal cancer, they will try to find out how advanced your cancer is by staging it. The stage of your cancer is determined by how deeply it has spread into the rectum and whether it has spread outside of the rectum. All rectal cancers—stages I though IV—may be treated with some type of proctectomy.

Ulcerative colitis may also be treated with proctectomy. Ulcerative colitis causes ulcers and infections to develop in the colon. In about 30 percent of people with ulcerative colitis, colon surgery is needed, and this surgery may include proctectomy. People with Crohn's disease, another type of inflammatory bowel disease, may undergo a proctectomy as well.

Risks of the procedure

Proctectomy is a major surgery that is usually done under general anesthesia during which you are put to sleep. Any general anesthesia includes the risk for heart or brain injury. Abdominal surgeries also carry the risk for dangerous blood clots forming in the large veins of your legs during or after surgery. These clots can break free and travel to your lungs, a condition called a pulmonary embolism.

Other risks of proctectomy include:

• Bleeding

• Infection

• Leaking through the surgically joined tissues and vessels

• Trouble passing urine

• Trouble passing bowel movements

• Delayed wound healing

• Sexual problems

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.

Before the procedure

Before proctectomy you will need a complete evaluation by your medical team to stage your cancer and plan your surgery. This may include special X-rays, blood tests, and a procedure called a colonoscopy to look inside your colon with a flexible, lighted scope and a tiny camera that transmits video images of the colon.

Other steps before surgery:

• Tell your doctor about any medications you are taking, including any over-the-counter drugs.

• If you are still smoking, ask your doctor how soon before surgery you need to quit.

• Special instructions before proctectomy may include stopping certain medications, taking medication to prevent blood clots, and taking antibiotics.

• Cleaning out your colon and rectum before surgery, a procedure called bowel prep, is a crucial part of preparation. This will include limiting your diet to clear liquids, taking medications that make you move your bowels, and having nothing to eat or drink the night before surgery. Follow your surgeon's bowel prep instructions carefully.

During the procedure:

• Cancers that can be reached through the anal opening and that have not spread too deeply may be removed by a surgical procedure called local excision.

• Cancers that are higher and deeper in the rectum may need to be removed by taking a larger section of the rectum out through an incision that goes through the lower abdomen. This is called a resection.

• If rectal cancer has not spread and there is enough tissue on either side of the cancer, the ends of the non-diseased intestinal tissues can be reconnected. This is called anastomosis. After proctectomy with anastomosis, a person can have normal bowel movements.

• If rectal cancer is too large and close to the anal opening, it may not be possible to spare the rectal area. In these cases a procedure called abdominoperineal resection (APR) may be needed. In APR surgery, the rectum is removed, the anal opening is closed, and the other end of the colon is attached to the outside of the lower abdomen. The new opening is called a colostomy. Bowel movements are collected in a special bag attached to the colostomy.

• A technique called minimally invasive laparoscopic surgery may be used during proctectomy. With this procedure, the surgeons operate through several small incisions with special instruments while watching the procedure on a television monitor.

After the procedure

You may need to stay in the hospital for a day or more after proctectomy. Once your doctors feel you have recovered enough to go home, it will be important to follow all your instructions for medications, pain control, diet, activity, and wound care.

If you have a colostomy after proctectomy, you may need to work with a colostomy caregiver. Make sure to keep all your follow-up appointments. He or she will show you how to use the ostomy pouch, deal with side effects such as skin irritation, and resume a full, active life. With proper care, the pouch cannot be seen under your clothing, and people will not even know you are wearing it.

Some other common instructions after proctectomy may include:

• Be up and walking as much as possible.

• Gradually resume normal activities; this may take a few weeks. Ask your doctors when you can resume bathing, driving, working, and sexual activity.

• Watch your wounds for any sign of swelling, redness, bleeding, or discharge.

• Let your doctor know about any increasing pain, chills or fever, or shortness of breath.