Proctectomy

Before a proctectomy, your healthcare provider will give you a complete physical exam to check the status of your overall health. They’ll use the results of the exam to stage your cancer (if you have it) and plan your surgery. You may also need imaging tests, blood tests and an ECG. If you haven’t gotten one already, your provider will request a colonoscopy as well.

Before surgery, you’ll have to do a bowel prep. This is essential to ensure your bowels are completely clean and cleared out before surgery. Your provider will prescribe a specific bowel prep regimen, which may involve changes to your medications and what you eat. You may also need to take laxatives or enemas.

You may need to stop taking certain medications, like blood thinners, before surgery. Discuss all medications with your provider to receive specific instructions.

Smoking can slow healing after a proctectomy and increase your risk of complications. If you smoke, your provider will recommend quitting well in advance of surgery.

Remember, the most important aspect of preparation is following your provider’s specific instructions. They’ll provide detailed information on what to expect before, during and after your surgery.

First, an anesthesiologist will give you general anesthesia. This will make you fall asleep so you don’t feel anything during the procedure.

The type of proctectomy you have will depend on the reason for the surgery and the location and size of the problem in your rectum. There are three main types of proctectomy:

• Abdominoperineal resection (APR): This is the most extensive proctectomy, removing your entire rectum, anus and sphincter muscles. Due to the removal of your sphincter muscles, you’ll need an ostomy to remove waste from your body. An ostomy is an opening created surgically, either in your ileum (lower part of your small intestine) called an ileostomy or in your colon called a colostomy. You then attach an external pouch to the opening to collect waste. You’ll need to empty this pouch regularly. Providers typically perform APR when the cancer is located very low in your rectum or has spread to your sphincter muscles.
• Low anterior resection (LAR): This surgery targets the lower portion of your rectum, aiming to preserve your sphincter muscles when possible. Depending on the remaining function of your rectum and what your surgeon recommends, you may or may not need an ostomy. If you don’t need an ostomy, your surgeon will reconnect your remaining rectum to your anus (anastomosis) to allow poop to go through the natural passage. LAR is generally preferred over APR when possible because it avoids the need for an ostomy and its associated lifestyle adjustments.
• Robotic-assisted rectal resection: This is a minimally invasive approach to a LAR procedure. It uses robotic arms for greater precision and control during surgery. Your surgeon sits at a console and manipulates the robotic arms to perform the dissection and reconnection. Potential benefits of robotic-assisted surgery include less blood loss, faster recovery time and potentially improved surgical precision.

The amount of time a proctectomy takes can vary depending on several factors, including:

• Type of proctectomy: An APR surgery, which is more complex, will generally take longer than a LAR procedure.
• Surgical complexity: The extent of the surgery itself plays a role. If there are additional procedures you need during surgery, like removing nearby lymph nodes, this will add to the operating time.
• Health factors: Your overall health and any underlying medical conditions can influence the surgery’s duration.

With these considerations in mind, a proctectomy can typically take anywhere from two to five hours. It’s important to remember that this is just a general timeframe, and the actual duration for your surgery may differ.

You’ll likely stay in the hospital for several days, up to a week, depending on your progress. Pain management will be a priority, with medication to keep you comfortable. You may have a catheter to drain urine (pee) and surgical drains to remove excess fluids from the surgical site. These are usually temporary.

You might not be able to eat solid foods at first as your digestive system recovers. You’ll gradually progress to a liquid diet and then a soft diet as tolerated. Physical therapy will be crucial to help you regain strength and mobility.

Before discharge, your healthcare team will provide detailed instructions on wound care, pain management, dietary modifications and any medications you’ll need to take at home.