Types of Surgery: Rectum

Key:
X = complete
* = partial
o = optional
• = see note under procedure

Tissues Removed
Rectum Recto-sigmoid Lymph nodes Sphincter Other Organs Permanent
Colostomy
Local tumor destruction without specimen
Includes cryosurgery, fulguration, laser surgery (vaporization), electrocautery		 *
Local excision with pathologic specimen
Includes endoscopic snare, excisional laser surgery, polypectomy		 *
Partial proctectomy X
Rectal resection, Not Otherwise Specified X X X o
Wedge or segmental resection X o o
Transsacral rectosigmoidectomy X X X
Hartmann's operation X X X rectal-
pouch		 descen-
ding
Anterior/posterior resection X X X
Pull-through resection with sphincter preservation; includes: Altemeier's operation, Soave's submucosal resection X o X
Duhamel's operation X X X sigmoid
Swenson's procedure X X X *
Turnbull procedure X o X pre-
served
Abdomino-perineal resection (complete proctectomy) descending
• anus, perineal skin, fat and nerves		 X X X X • X
Miles' operation
• perianal excision of rectum and anus		 X X X X • X
descen-
ding
Rankin's operation X o X X X
Pelvic exenteration (partial or total) X o X X X X
Surgery of regional and/or distant sites or nodes */X

AP Resections — how to tell what the initials mean

There is no published guideline for determining whether this abbreviation refers to Anterior/Posterior or Abdominoperineal resections, but some of the distinguishing characteristics are listed below.

Abdominoperineal resection is performed for very low lesions in the rectum (lower third—within 5 cm of anal verge). An abdominoperineal resection, in addition to removing the entire rectum, most of the sigmoid colon, the mesocolon and its regional lymph nodes, removes the anal sphincter and leaves the patient with a permanent colostomy. Because of the resulting colostomy, this procedure is done only in circumstances where it is absolutely necessary. This procedure may also be called a Miles' or a Rankin's procedure. Review the x-rays, endoscopy, op report and/or path report for an indication that the tumor is very low in the rectum or that the path specimen contained the anal sphincter muscle. An enterostomal therapist report may also give you some indication that the patient will have a permanent colostomy.

Anterior/Posterior resection is performed for other lesions in the rectum and rectosigmoid (above 5 cm from anal verge). This procedure is usually called a low anterior resection, but may have a posterior approach in certain situations. An Anterior/ Posterior resection preserves the anal sphincter and preserves bowel continuity by creating an anastomosis after the segment of bowel containing the tumor is removed. You will see references to autosuture devices or intraluminal stapling devices in the op report as the anastomosis is constructed. The patient may have a temporary colostomy which is closed at a later date.

The general guideline is to look at the location of the tumor: if it is below 5 cm from the anal verge, AP probably stands for Abdominoperineal; if it is above 5 cm, it probably means Anterior/Posterior.