WikiAnesthesia - User contributions [en]

Abdominoperineal resection

2026-04-18T05:43:54Z

Kodyarmann:

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = PIVs, consider arterial line
| monitors = Standard +/- arterial line
| considerations_preoperative = Consider epidural analgesia
| considerations_intraoperative = Blood loss, positioning
| considerations_postoperative = PONV, analgesia
}}

An abdominoperineal resection (APR) is a colorectal surgery that includes the resection of the sigmoid colon, rectum, and anus with construction of a permanent end colostomy. The procedure can be performed robotically/laparoscopically or open.

== Overview ==

=== Indications<ref name=":0">{{Cite web|title=UpToDate|url=https://www.uptodate.com/contents/abdominoperineal-resection-apr-open-techniques#H27174094|access-date=2026-04-18|website=www.uptodate.com}}</ref> ===
●Crohn proctitis with anal disease

●Ulcerative colitis, not a candidate or amenable to an ileal pouch anal anastomosis

●Fecal incontinence, not amenable to sphincter-sparing procedures

●Low-lying rectal cancer involving anal sphincter complex and/or positive distal margin

●Anal cancer, failed neoadjuvant therapy

●Anal cancer, recurrent

●Anal melanoma

=== Surgical procedure<ref name=":0" /> ===
Exploration for respectability, mobilization of colon, mobilization of rectum, colostomy construction, omental flap, repositioning for perineal resection, perineal resection, perineal wound closure

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Neurologic
|Consider epidural analgesia vs regional anesthesia for open approach
|-
|Cardiovascular
|Careful attention to fluid management with open abdomen especially if patient received a bowel prep
|-
|Gastrointestinal
|Assess for nausea and vomiting prior to induction
|-
|Hematologic
|Type and screen

Potential for anemia of chronic disease

Obtain platelet count if planning on epidural
|-
|Renal
|Consider prerenal injury from bowel prep especially if patient already has decreased PO intake in the setting of malignancy
|}

=== Operating room setup===

* Standard OR preparation
* Fluid warmer and Bair hugger
* OG vs NG tube

=== Patient preparation and premedication ===

* Patients often have bowel prep
** Patients typically dehydrated and may have electrolyte abnormalities
* Consider pre-loading patients that are hypovolemic
* Presurgical ERAS protocol

=== Regional and neuraxial techniques ===

* Consider preoperative epidural placement for open approach vs regional anesthesia

== Intraoperative management ==

=== Monitoring and access ===

* Standard ASA monitors
* 5-lead EKG
* Urinary catheter
* 2 peripheral IVs, at least one large bore
* Consider arterial line

=== Induction and airway management ===

* Standard induction and intubation
* Consider need for RSI if patient endorses nausea or vomiting

=== Positioning ===

* Emphasis on careful patient positioning given length of procedure
* Positioning typically begins in modified dorsal lithotomy with adequate padding to prevent common peroneal nerve injury
* After completion of the abdominal portion, the perineal portion can typically be completed while still in the lithotomy position with repositioning of the legs. Prone jackknife position may be requested depending on the surgeon.

=== Maintenance and surgical considerations ===

* Standard maintenance with either inhalational agent or TIVA
*Consider short acting opioids to minimize the risk of postoperative ileus if no epidural was placed
*Operative time will be prolonged if plastic surgery is required for a perineal flap

=== Emergence ===

* Standard emergence and extubation strategies with patient awake and able to protect airway
* PONV prophylaxis

== Postoperative management ==

=== Disposition ===

* Patients are typically able to go to the PACU followed by a floor bed after recovery. Consider an ICU disposition for patient comorbidities, significant intraoperative blood loss and resuscitation.

=== Pain management ===

* Epidural analgesia if placed preoperatively
* Consider non-opiate adjuncts
*Multi-modal pain management
*May have APS consult if uncontrolled pain or ERAS protocol depending on surgeon

=== Potential complications ===

* Hemorrhage
* Anastomotic leak leading to sepsis/septic shock
* High risk for VTE
* Compartment syndrome if legs remain down for a prolonged time with significant fluid/blood resuscitation
* PONV

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Open
!Laparoscopic/Robotic
|-
|Unique considerations
|More insensible losses/fluid shifts
More painful
|
|-
|Position
|Supine, lithotomy, possible prone for pelvic portion
|Supine, lithotomy, possible prone for pelvic portion
|-
|Surgical time
|6-12 hours
|6-12 hours
|-
|EBL
|100-500ml
|<100ml
|-
|Postoperative disposition
|PACU
|PACU
|-
|Pain management
|Multimodal analgesia, epidural anesthesia, PCA, regional
|Multimodal analgesia, opioids, regional
|-
|Potential complications
|Hemorrhage, VTE, hypovolemia, PONV
|Possible difficulty ventilating during insufflation
|}

== References ==

# "UpToDate". ''www.uptodate.com''. Retrieved 2026-04-18.

[[Category:Surgical procedures]]

Abdominoperineal resection

2026-04-18T02:32:55Z

Kodyarmann:

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = PIVs, consider arterial line
| monitors = Standard +/- arterial line
| considerations_preoperative = Consider epidural analgesia
| considerations_intraoperative = Blood loss, positioning
| considerations_postoperative = PONV, analgesia
}}

An abdominoperineal resection (APR) is a colorectal surgery that includes the resection of the sigmoid colon, rectum, and anus with construction of a permanent end colostomy. The procedure can be performed robotically/laparoscopically or open.

== Overview ==

=== Indications<ref name=":0">{{Cite web|title=UpToDate|url=https://www.uptodate.com/contents/abdominoperineal-resection-apr-open-techniques#H27174094|access-date=2026-04-18|website=www.uptodate.com}}</ref> ===
●Crohn proctitis with anal disease

●Ulcerative colitis, not a candidate or amenable to an ileal pouch anal anastomosis

●Fecal incontinence, not amenable to sphincter-sparing procedures

●Low-lying rectal cancer involving anal sphincter complex and/or positive distal margin

●Anal cancer, failed neoadjuvant therapy

●Anal cancer, recurrent

●Anal melanoma

=== Surgical procedure<ref name=":0" /> ===
Exploration for respectability, mobilization of colon, mobilization of rectum, colostomy construction, omental flap, repositioning for perineal resection, perineal resection, perineal wound closure

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Neurologic
|
* Consider epidural analgesia vs regional anesthesia for open approach
|-
|Cardiovascular
|
* Careful attention to fluid management with open abdomen especially if patient received a bowel prep
|-
|Gastrointestinal
|
* Assess for nausea and vomiting prior to induction
|-
|Hematologic
|
* Type and screen
* Potential for anemia of chronic disease
* Obtain platelet count if planning on epidural
|}

=== Operating room setup===

* Standard OR preparation
* Fluid warmer and Bair hugger
* OG vs NG tube

=== Regional and neuraxial techniques ===

* Consider preoperative epidural placement for open approach vs regional anesthesia

== Intraoperative management ==

=== Monitoring and access ===

* Standard ASA monitors
* 5-lead EKG
* Urinary catheter
* 2 peripheral IVs, at least one large bore
* Consider arterial line

=== Induction and airway management ===

* Standard induction and intubation
* Consider need for RSI if patient endorses nausea or vomiting

=== Positioning ===

* Emphasis on careful patient positioning given length of procedure
* Positioning typically begins in modified dorsal lithotomy with adequate padding to prevent common peroneal nerve injury
* After completion of the abdominal portion, the perineal portion can typically be completed while still in the lithotomy position with repositioning of the legs. Prone jackknife position may be requested depending on the surgeon.

=== Maintenance and surgical considerations ===

* Standard maintenance with either inhalational agent or TIVA. Consider short acting opioids to minimize the risk of postoperative ileus.

=== Emergence ===

* Standard emergence and extubation strategies with patient awake and able to protect airway
* PONV prophylaxis

== Postoperative management ==

=== Disposition ===

* Patients are typically able to go to the PACU followed by a floor bed after recovery. Consider an ICU disposition for patient comorbidities, significant intraoperative blood loss and resuscitation.

=== Pain management ===

* Epidural analgesia if placed preoperatively
*

=== Potential complications ===

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Indications
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

# "UpToDate". ''www.uptodate.com''. Retrieved 2026-04-18.

[[Category:Surgical procedures]]

Abdominoperineal resection

2026-04-18T01:59:50Z

Kodyarmann: Article creation

{{Infobox surgical procedure
| anesthesia_type =
| airway =
| lines_access =
| monitors =
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}

Provide a brief summary here.

== Overview ==

=== Indications ===

=== Surgical procedure ===

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===

=== Operating room setup ===

=== Patient preparation and premedication ===

=== Regional and neuraxial techniques ===

== Intraoperative management ==

=== Monitoring and access ===

=== Induction and airway management ===

=== Positioning ===

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Indications
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]