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Low Anterior Resection - Preoperative Preparations and Complications

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Low Anterior Resection is the surgical removal of the rectum and the sigmoid colon.

Medically reviewed by

Dr. Pandian. P

Published At December 21, 2022
Reviewed AtJanuary 24, 2023

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.

  • 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.

Frequently Asked Questions

1.

What Is the Post-operative Process After Undergoing a Low Anterior Resection?

Initially, patients are closely monitored in the recovery room for immediate post-operative care.Medication is used to treat pain, and patients are also urged to move and do breathing exercises to avoid problems. The diet is gradually advanced, starting with clear fluids and progressing to a regular diet as tolerated. Patients may have transient changes in bowel habits and bowel dysfunction, which should return to normal over time. Appointments for follow-up care are planned to track the healing process and address any issues. The overall goals of the post-operative process are to assure proper pain management, encourage early mobilization, improve bowel function, and support a quick recovery.

2.

Why Is the Surgical Procedure Called a Low Anterior Resection?

A piece of the rectum is removed during surgery, and the remaining rectum is then joined to the colon at a lower place, hence the name "low anterior resection." The term "anterior" refers to the location of the rectum in front of the sacrum, while "low" indicates that the resection occurs closer to the anal canal. By using this technique, surgeons may preserve the anal sphincter muscles, minimizing the chance of developing bowel incontinence.

3.

Is Low Anterior Resection Considered a Major Surgery?

Yes, low anterior resection is considered major surgery. This surgery, requiring general anesthesia, is normally carried out in a hospital. It could result in risks and issues like bleeding, infection, harm to adjacent organs, and anastomotic leaks. The healing process can take some time, and normal activities should only be resumed gradually. Due to the complexity of the procedure and the potential impact on bowel function, low anterior resection is classified as a major surgical intervention.

4.

What Is the Rate of Complications Associated With Low Anterior Resection?

The incidence rate for short-term complications, including surgical site infections and ileus, ranges from 10 % to 30 %. In roughly 9.1 % to 17.8 % of instances, anastomotic leakage, a severe consequence, has been documented. Other potential complications include urinary retention, deep vein thrombosis, and pulmonary complications. Complications may occur depending on the patient's characteristics, the surgical procedure, and the post-operative treatment.

5.

Where Is the Surgical Port Typically Placed for a Low Anterior Resection?

A low anterior resection (LAR) often involves placing the surgical port in the lower abdomen. It is commonly positioned at the level of the umbilicus or slightly below it. Depending on the patient's anatomy and the surgeon's preferences, the precise site might differ. The port acts as an access point for laparoscopic tools, providing access for the surgeon to carry out the procedure. Proper placement of the surgical port enables optimal visualization and manipulation of the affected area while minimizing the risk of complications.

6.

What Dietary Restrictions or Recommendations Exist After Undergoing LAR Surgery?

 
A clear liquid diet is often advised at first to give the digestive system time to recover. The diet is advanced over time to incorporate low-fiber items such as lean proteins and prepared vegetables. It's vital to stay clear of meals like beans and carbonated drinks that can result in gas or bloating. Drinking plenty of fluids and maintaining hydration is crucial. Over time, it is advised to consume more fiber as part of a regular, well-balanced diet to promote bowel function and general health. Adapting the diet to individual needs requires following the advice of a medical professional or qualified dietitian.

7.

How Long Does It Take To Recover From a Low Anterior Resection?

Generally, it takes several weeks to a few months for individuals to recover fully.  Fatigue and discomfort are frequent in the first several weeks and eventually go away. It can take up to two months to get back to your regular routine. However, factors including general health, age, and the existence of any problems might have an impact on each person's recovery timeframe.

8.

What Is the Duration of a Low Anterior Resection Surgery?

The surgery normally takes 2 to 4 hours to complete on average. The complexity of the procedure, the anatomy of the patient, and the type of surgery (open or laparoscopic) can all affect how long it actually takes. The duration may also be impacted by the surgeon's experience and the existence of any unexpected finds.

9.

Is Low Anterior Resection Performed as an Open Surgery or Laparoscopic Procedure?

 
Laparoscopic surgery or open surgery can both be used to conduct a low anterior resection (LAR). In open surgery, a larger abdominal incision is made to reach and remove the affected rectum area. Contrarily, laparoscopic LAR is a minimally invasive procedure in which a camera and specialized surgical tools are inserted through a series of tiny incisions. In comparison to open surgery, laparoscopic LAR may have advantages such as less postoperative discomfort, shorter hospital stays, and quicker recovery. The decision between open surgery and laparoscopic LAR is influenced by the patient's health, the surgeon's skill, and the existence of any laparoscopic surgical contraindications.

10.

Is a Stoma Required After Undergoing a Low Anterior Resection?

 In some cases, a temporary stoma may be created to divert the flow of feces and allow the newly reconnected bowel to heal. This transient stoma may be later surgically reversed. However, a permanent stoma may be required in some circumstances, such as severe illness or complications. The surgeon normally decides whether or not a stoma is necessary depending on the patient's general health, the location of the tumor, and the state of the intestine.

11.

What Is the Most Common Complication Following Colorectal Surgery?

Anastomotic leaking is one of the most frequent side effects following colorectal surgery. This is the term used to describe the leakage of intestinal contents at the location of the surgically performed bowel connection. Anastomotic leaking can result in infection, the development of an abscess, and other life-threatening consequences. It may occur in around 3 to 19 percent of colorectal surgeries. Risk factors for anastomotic leakage include factors such as poor blood supply to the bowel, obesity, smoking, and pre-existing medical conditions.

12.

What Type of Anesthesia Is Typically Used for Low Anterior Resection?

 A low anterior resection (LAR) is frequently performed under general anesthesia. During surgery, the patient is put under general anesthesia, which involves giving them drugs to make them unconscious and render them completely unresponsive. This guarantees the patient's comfort and pain-free passage through the process. The use of general anesthetic enables the surgical team to carry out the LAR safely, effectively, and with the patient's comfort and well-being in mind.

13.

Is Colon Resection Considered a Risky Procedure?

Colon resection is generally considered a safe and well-established surgical procedure.  However, it has inherent risks and potential consequences much like any surgical operation. The patient's general health, the existence of underlying illnesses, and the complexity of the particular case, among other variables, can all affect the risk level.
Source Article IclonSourcesSource Article Arrow
Dr. Pandian. P
Dr. Pandian. P

General Surgery

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