Low Anterior Resection - Preoperative Preparations and Complications

Introduction:

A low anterior resection is a surgical procedure to remove a part of the rectum and the sigmoid colon while snagging up the rectum that is left with the colon end portion. This hooking up is called anastomosis and is acquired during the low anterior resection procedure by the colon, and the rectum is stitched or stapled around concurrently. The objective of a low anterior resection process is the corrective extraction of a malignant tumor of the rectus.

What Is Low Anterior Resection?

• A low anterior resection is a typical surgical procedure done for rectal cancer. It includes the expulsion of the rectum. The colon is connected to the remaining area of the rectum to permit normal bowel movement. Low anterior resections are utilized to manage stage two and three rectal tumors. In addition, it can treat superior, middle, and inferior rectal tumors.

• Lower anterior resection is executed for the disease in the middle and superior third of the rectum and the disease in the inferior third. Thus it is a major operation. Patients should be in acceptable health condition. The patient should not have had sphincter problems before this procedure or should not have any proof of extensive pelvic localized disease. The resection is accomplished under general anesthesia, and the patient is arranged into sleep; thus, they would not sense pain. During the procedure, they will make multiple small incisions in the belly. Cancer and a border of normal tissue around the malignancy are cleared, along with adjacent lymph nodes and tissues adjacent to the rectum.

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• The colon is rejoined to the rectum that remains, so an enduring colostomy is not required. However, it is required if rejoining the colon and rectum. The upper colon end is connected to an entrance created in the skin of the abdomen. The stool comes out through this entrance.

What Is the Requirement of Ileostomy After Low Anterior Resection?

Patients undergoing low anterior resection require ileostomy for some time post-surgically. An ileostomy is a procedure in which a tiny entrance is created in the belly. Through it, bowel movements and waste can exit the body. The ileostomy maintains the bowel movements from departing via the colon and rectum.

This procedure is mandatory as it helps the anastomosis to heal better. In an ileostomy procedure, a portion of the small intestine is carried out via the slot created in the abdomen while in the surgical procedure. The portion of the intestine that is the present outer portion of the body is named a stoma. The stoma is pink, a glimpse shiny, and will be moist. Thus bowel movements and air created will exit through the stoma and move into the plastic pouch that encircles the stoma. Before the surgery, the operator will know if the patient requires a temporary ileostomy procedure. But the absolute conclusion is made at the time of the procedure. In a temporary ileostomy procedure, a wound, ostomy, and continence nurse assistance are required pre and postoperatively. The ileostomy is sealed for some months post-surgically. In some rare cases, a permanent ileostomy is required.

What Are the Preoperative Preparations Done in Low Anterior Resection?

A complete medical history should be taken to find if the patient is taking a blood thinner, like Aspirin, Heparin, Warfarin, Clopidogrel, Enoxaparin, Dabigatran, Apixaban, and Rivaroxaban. Suppose the patient takes any diet complements, like herbs, vitamins, and minerals, if the patient has a pacemaker, automatic implantable cardioverter-defibrillator, or other implants.

Patients have any disorder like sleep apnea. Patients have any issues with the administration of anesthesia. They have allergies, blood transfusion issues, smoking history, or alcohol intake.

• In patients with alcohol intake, certain measures should be taken. Thus It is necessary to discuss with the surgeon the quantity of alcohol intake. If the patient ceases alcohol intake abruptly, it may lead to seizures, delirium, and death. If the surgeon is aware of this condition, he can prescribe medicines to prevent them from happening. In cases of daily alcohol intake, the patient is at risk of problems preoperatively and postoperatively. It involves blood loss, infections, heart problems, and increased length of hospital stay. Thus patients are advised to discontinue their intake of alcohol once the procedure is scheduled. The early indications of alcohol withdrawal can be managed.

• If the patient has a smoking habit, there is a chance of developing breathing difficulties. Thus they were advised to quit smoking for some days before the surgery.

• Sleep apnea is typical breathing difficulty. It causes the patient to quit breathing for a temporary period while the patient is asleep. The standard variety is obstructive sleep apnea. The patient's airway becomes fully blocked during sleep with obstructive sleep apnea. Also, obstructive sleep apnea can induce serious difficulties at the time of surgery and after surgery. Thus it is mandatory to discuss with the patient if they have obstructive sleep apnea or use devices.

• Pre-surgical test (PST) appointment is needed before the surgery. The schedule is planned accordingly. The patient is asked to have the usual medication. The test includes an electrocardiogram to check the heart's rhythm, a chest X-ray, and blood tests.

What Are the Complications of Low Anterior Resection?

All perioperative complications include blood loss due to bleeding. Injury to the ureter and anastomosis can also occur during the operative period. A wound is infected if cellulitis was experimental and antibiotics were administered, or in an opened wound with purulent discharge or does not have discharge with antibiotic management.

Anastomotic leaks can occur in some cases-Gastrografin enema. The pelvic abscess is also a complication. Perioperative death may occur during surgery or after thirty days post-surgically.

Conclusion:

Laparoscopic surgery has been used most effectively. It has substituted open colonic procedures in current decades owing to favorable fast-term effects, such as reduced pain, decreased blood loss, and increased rehabilitation, with better outcomes corresponding to the conventional open approach. In the last decades, the reduced invasive procedure for cancer has been studied actively.