A low anterior resection (LAR) is a type of surgery to remove part or all of your rectum. The rectum is the lower part of the large intestine, about six inches long which connects the colon above it with the anus below it. This is also called:

Low Anterior Resection

What is a low anterior resection?

A low anterior resection (LAR) is a type of surgery to remove part or all of your rectum. The rectum is the lower part of the large intestine, about six inches long which connects the colon above it with the anus below it. This is also called:

• Restorative proctectomy (because it lets your bowel be reconnected like before)
• Sphincter-sparing surgery (because it keeps the sphincter muscles that control your bowels)

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Conditions where this surgery is recommended

• The tumour has to be high enough in your rectum that your surgeon can safely remove it without damaging your anus.

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What tests are done before the surgery?

• Blood tests to look for any signs of cancer spreading
• Inserting a thin flexible tube through your anus to look at your colon. The doctor will sometimes take a sample of tissue along with this
• CT, or other imaging tests

Based on these results, your doctors will discuss whether you should have other treatments first, what type of surgery to have (open or laparoscopic) whether to create a temporary opening to collect waste while your rectum heals.

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Preparing for the surgery

Before the surgery, your doctor will instruct you about:

• What medicines to take
• What you can and can’t eat/drink
• How to clean out your bowels with an enema

What happens immediately before the surgery

• You will lie on the operating table on your back with your head below your hips. This tilts the organs up a little, giving the surgeon better access to your abdomen
• Thes surgeons give you general anaesthesia to put you to sleep during the procedure
• A tube to help you breathe and a tube to drain your stomach are also attached

Surgical procedure

• If done via open surgery, a long cut is made in your abdomen
• If done via laparoscopic surgery, a small cut is made in your abdomen in which a tiny camera is inserted. A few more cuts are made where the surgical instruments are inserted
• The surgeon cuts and removes the tumour and a bit of the healthy tissue around it to ensure he gets the complete tumour
• Free up your remaining healthy large bowel so it can reach your remaining rectum or anus.
• Reconnect the remaining sections of your large bowel.
• Your surgeon may create a temporary ostomy to help your bowel healThis diverts stool (poop) away from the place where your bowel was reconnected, reducing the risk of leakage and infection.Stool will now leave your body through the stoma and collect into an ostomy bag that you’ll wear on your belly. You’ll empty the bag several times during the day.
• This diverts stool (poop) away from the place where your bowel was reconnected, reducing the risk of leakage and infection.
• Stool will now leave your body through the stoma and collect into an ostomy bag that you’ll wear on your belly. You’ll empty the bag several times during the day.

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Risks/complications of the surgery

• Bleeding
• Infection
• Leaking where your bowel was reconnected
• Nerve damage that affects your bladder control or sexual function

Most of these problems are short-term and treatable. But sometimes, nerve damage can be lasting.

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Recovery

• You will stay in the hospital for a few days after the surgery to recover
• You will be given antibiotics and pain medicines to help you recover
• You will be on a liquid diet for a few days
• You might have a catheter attached to drain your urine for some
• You will be asked to move around a little every day
• You’ll be ready to go home when:Your bowels and bladder are working well.You can move around comfortably on your own.You’re eating solid foods.You can tolerate pain medicine by mouth
• Your bowels and bladder are working well.
• You can move around comfortably on your own.
• You’re eating solid foods.
• You can tolerate pain medicine by mouth
• You might need some help with house work and meal preparation once you go home
• The doctor might slowly reduce the dose of your pain medicine
• You’ll meet with your doctor every few weeks to check on your recovery
• If you have a temporary ostomy, you can talk to your surgeon about reversing it after your cancer treatment is complete.

Advantages of LAR over other surgeries

• It leaves your anus intact
• The ostomy bag is temporary

Drawbacks or risks of LAR surgery

• Frequent and urgent, uncontrollable bowel movements
• Difficulties with urinary control

When to contact a doctor?

• Your pain gets worse or doesn’t go away.
• Your stoma looks red, swollen or infected.
• You have a fever or a swollen belly.
• Your ostomy is draining too much and you’re getting dehydrated.

What is an abdominoperineal resection?

An abdominoperineal resection (APR) is a type of done to treat rectal cancer in which the anus, rectum and part of the colon is removed. In this surgery, a colostomy bag is permanently attached

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Preparing for an APR surgery

• Tests include blood tests, and CT and MRI scans
• You will be guided by a nurse on how to use and clean an ostomy bag
• Your doctor will review the following: Your smoking and drinking history. You will be sked to stop both many days before the surgery Check about any possible sleeping issues You will be put on a liquid diet before the surgery You w will also be asked to get an enema Review all the medicines you are prescribed
• Your smoking and drinking history. You will be sked to stop both many days before the surgery
• Check about any possible sleeping issues
• You will be put on a liquid diet before the surgery
• You w will also be asked to get an enema
• Review all the medicines you are prescribed

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Surgical procedure

• Done under general anaesthesia where you are completely asleep
• The surgeon makes small cuts in your abdomen
• Remove part of your colon, your rectum and your anus
• Remove special glands called lymph nodes to prevent the cancer from spreading
• Close the skin below your rectum, which means you won’t have an opening there
• Do a permanent colostomy at the spot chosen before surgery

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Risks/complications of the surgery

• Bleeding
• Blood clots in your legs that can travel to your lungs
• Damage to nearby tissues
• Pneumonia
• Infection
• Heart attack
• Stroke.

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Recovery

• You will be in the hospital for several days
• A temporary tube to drain your urine will be attached
• You will be given antibiotics and pain medicines to help you recover
• A drainage tube in your belly will also be attached that your care team will eventually remove.
• You will initially be started on soft foods and liquids
• You will be asked to move around a little every day
• You’ll be ready to go home when:Can eat soft foodsPoopManage pain with medication that you can take at homeFeel comfortable caring for your ostomy
• Can eat soft foods
• Poop
• Manage pain with medication that you can take at home
• Feel comfortable caring for your ostomy
• You may have a home health nurse who will come to your home to help you with your ostomy

Activities to avoid

• Activities which involve going in water like swimming, use of bathtubs (showers will be allowed)
• Lifting heavy objects
• Driving (at least while you are on heavy pain killers

When to contact a doctor?

• Severe belly pain even after you take pain medication
• Fever of 101.5 degrees Fahrenheit (38.6 degrees Celsius) or higher
• Nausea and vomiting
• Constipation or diarrhea
• Redness, swelling or pain at the incision sites
• Difficulty with your ostomy

Myths and Facts

Frequently Asked Questions (FAQs)