What is an anterior resection?

Anterior resection is resecting part of or all of the rectum. When the area of disease is resected, the two ends of the remaining healthy bowel are then joined usually by stapling (anastomosis).

Why do I need this procedure done?

Anterior resection is needed to treat conditions such as:

  • Rectal cancer or pre-cancerous polyp
  • Inflammatory bowel disease
  • Fistula (communication between the rectum and another organ)

What is a stoma?

A stoma is an opening of the bowel onto the skin which is formed during surgery by stitching a section of the bowel onto the abdomen. Stools that come out of the stoma are collected in a bag that covers it.

A stoma can be permanent when joining the bowel after resection is not feasible, or temporary for the stool to bypass the anastomosis. Temporary stomas are usually reversed approximately three months after formation

What are the risks associated with anterior resection?

  • Anastomotic leak – Sometimes the anastomosis (where the bowels are joined) leaks. The risk is approximately 5-15% (depending on how low is the anastomosis). This could range from a mild leak that can be managed with antibiotics to a sever one that results in severe infection and the need for urgent surgery.
  • Post-operative bleeding – Blood transfusion may be needed to replace lost blood. Occasionally urgent surgery is needed to stop the bleeding
  • Damage to the ureter – The ureter is the tube that brings urine from the kidney to the bladder and is located immediately behind the colon and rarely it gets injured during surgery. This may require further surgery for repair
  • Bladder dysfunction – Bladder may not empty properly or may empty without warning. This is due to injury to the nerves supplying the bladder during the surgery
  • Sexual dysfunction – Men may be unable to get an erection or keep an erection. It may also mean that they cannot ejaculate. In women it may cause pain during or after intercourse. For most men and women, this improves with time
  • Ileus – The bowel is paralysed leading to abdominal bloating, and vomiting. You will be asked to fast until there is evidence of passage of stool or flatus. A tube may be passed into the stomach through the nose to suction the stomach to prevent vomiting and aspiration
  • Small bowel obstruction – Adhesions (bands of scar tissue) may develop inside the abdomen and the bowel may block. This is a short term and long-term complication. Most small bowel obstructions resolve with non-operative management, but some may need further surgery
  • Incisional hernia – Hernias can develop over port sites or specimen extraction sites during laparoscopic surgery and over the long incision of open surgery
  • Change in bowel habit – Bowel habits will change. Bowel function may be erratic. Stools may be looser, smaller and more frequent. There may be some leakage of stools particularly at night depending on the type of surgery. In most people, this improves with time, without further treatment
  • Wound infection
  • Urinary tract infection

There are other general risks associated with surgery

  • DVT – Blood clot in the leg (DVT) causing pain and swelling. In rare cases part of the clot may break off and go to the lungs
  • Chest infection
  • Heart attack or stroke could occur due to the strain on the heart.
  • Death, as a result of this procedure, is rare but possible (~1%).

What is low anterior resection syndrome?

Low anterior resection syndrome (LARS) is a collection of symptoms that can occur to patients after an anterior resection. Symptoms include:

  • Frequency or urgency of stools, largely due to the fact you have less space to store stool after removing part of the rectum
  • Clustering of stools (many bowel movements during a few hours)
  • Faecal incontinence (lack of control over bowel movements)
  • Constipation for more than a few days, followed by multiple bowel movements a few days later
  • Increased gas
  • Abdominal pain
  • Small risk of urinary and/or sexual function due to nerve damage

Conservative therapies such as pelvic floor rehabilitation or colonic irrigation are the basis of the current treatment of low anterior resection syndrome