Lap assisted Abdomino Perineal Resection for Ca rectum
Cancer found on the lower part of rectum is removed by this operation. In this operation anus, rectum and sigmoid colon are removed. An opening called stoma is provided usually on the left side of the lower part of the abdomen which is connected to the large intestine. The waste from the body is passed out through this stoma. This artificial outlet provided for human waste is not having any sphincter muscles which are found in an anus. So it is not possible to have control over the removal of waste. A pouch is attached to the stoma in which the human waste is collected continuously. This pouch is either cleared or changed periodically. This operation is carried out in four steps which are explained below.
Step 1. Arranging the laparoscope: When the patient is sleeping the surgeon will create a cut about 10 to 15 mm near the bottom of his belly. Laparoscope is inserted to the belly through this incision and is used to send the images taken to the monitor placed near the surgeon. A few more keyholes are made in the abdomen through which the surgical instruments are allowed to enter the body using which the surgery is carried out.
Step 2. Separating of sigmoid colon and rectum: Surgeon cuts and closes the veins carrying blood to sigmoid colon and rectum. Surgeon now cuts the sigmoid colon and rectum and keeps it ready for removal.
Step3. Removal of sigmoid colon, rectum and anus: One of the surgeons will operate the perennial region (the area between the legs). Surgeon now cuts the anus and through this passage the anus, sigmoid colon and the rectum are removed out of the body.
Step 4. Making the stoma: The open end of descending colon is pulled out through an opening on the left side of the abdomen. The cavity through which the colon was taken out will be rinsed well and a tube will be connected to the colon which will help the removal of the waste. After completing this, surgeon will finally inspect the cavity and stitch the cavity. A pouch is connected to the stoma for collecting the waste that is coming out of the stoma.
Dr.Kalpana in a panel on PCOS infertility Indian fertility society conference