abdominoperineal resection
Meaning of abdominoperineal resection: The name records both incisions, one in the abdomen and one around the anus, and because the anus goes, the stoma is permanent.
Definition of abdominoperineal resection
An abdominoperineal resection is surgery that removes the anus, the sphincter muscles around it, the rectum and the lower sigmoid colon, working through an incision in the abdomen and a second incision around the anus. The cut end of the colon is brought out through the abdominal wall as a permanent colostomy. Nearby lymph nodes are taken with the specimen.
Why are two incisions needed?
The rectum sits deep in the bowl of the pelvis and the anus opens on the outside of the body, so no single approach reaches both ends of the specimen. From above, through the abdomen, the colon is divided and the rectum freed downward along with the fatty envelope holding its lymph nodes. From below, a cut circling the anus frees it and the sphincter muscles from the surrounding tissue. The two dissections meet in the middle of the pelvis and the whole piece is delivered through the lower opening in one block. The perineal wound is then closed, sometimes with muscle or mesh brought in to fill the cavity left behind.
How does it differ from sphincter-sparing surgery?
| Operation | What is removed | Bowel continuity | Stoma |
|---|---|---|---|
| Abdominoperineal resection | Rectum, anus and sphincters | Cannot be restored | Permanent colostomy |
| Low anterior resection | Rectum, sphincters left behind | Colon joined to what remains | Temporary, or none |
The choice turns on whether a margin of healthy tissue can be left below the tumor without sacrificing the muscles that hold stool in. It is reserved for tumors growing into the sphincters or sitting too low to clear, and for those whose continence is already lost. Treatment given before surgery has shrunk some tumors enough to allow the lesser operation, and anal cancer is now treated first with chemotherapy and radiation, so the number of these resection procedures performed has fallen.
What changes afterward?
Stool leaves through the colostomy into an appliance on the abdomen for life. The perineal wound heals slowly and can break down, particularly where radiation has been given. Nerves running along the pelvic side walls control the bladder and sexual function and can be bruised or divided during the dissection. Many people describe a persistent urge to pass stool from an anus that no longer exists.
Also known as
Used in a sentence
An abdominoperineal resection was performed for a low rectal tumor involving the sphincter complex.
Good to know
The perineal incision named in the term is what distinguishes the operation, since removing the anus and its sphincters makes the colostomy permanent and rules out any later restoration of bowel continuity.
Word origin
Where “abdominoperineal resection” comes from
Abdomino- comes from the Latin abdomen, perineal from the Greek perineos for the region between the thighs, and resection from the Latin resecare, to cut back.