What is Proctectomy?

Proctectomy is the surgical removal of the rectum, which, along with the anus and colon, is part of the large intestine. Rectal resection (removal) is used in the treatment of cancers and inflammatory bowel disease (IBD). For rectal cancers that have not spread outside of the large intestine, proctectomy is the primary treatment option.

The type of proctectomy performed depends on the severity and location of your cancer. If the cancer is confined to the rectum, only the rectum will need to be removed. Surgery can be done transanally, without an incision on the stomach, if the cancer can be reached through the anus.

For cancers higher in the rectum (closer to the colon), a low anterior resection is done. Low anterior resection uses an incision on the abdomen to access the cancerous portions of the rectum. The remaining parts of your large intestine can be connected in a procedure called anastomosis, and waste can exit through your anus as usual. In some cases, your surgeon may choose to perform a type of anastomosis called temporary ileostomy. This involves attaching the end of the small intestine (ileum) to an opening in your abdomen (stoma), through which waste will exit your body and be collected in a small pouch. This is done if you have previously undergone other cancer treatments, such as chemotherapy, to give the remaining ends of the large intestine time to heal before waste passes through them again. The ends will be reconnected at a later date, typically within several weeks.

For rectal cancer that has spread to the anus, abdominoperineal resection is an option. Abdominoperineal resection removes the cancerous lower rectum along with part or all of the anus and, sometimes, part of the colon. Removing part of the anus can lead to waste leaking, so a permanent colostomy is always done during abdominoperineal resection. Colostomy is similar to ileostomy, but instead of the ileum, the end of the colon is attached to a stoma, through which waste will flow into a collection bag. Your surgeon will make incisions in the abdomen and around the anus to perform this procedure.

For the treatment of inflammatory bowel disease, proctocolectomy is done. IBD causes infections and ulcers to occur in the colon, but it can spread to other parts of the large intestine as well, such as the rectum. If this is the case, removing the rectum along with the colon in a proctocolectomy can be used to treat IBD in the event that it has not responded to conservative approaches, such as medication.

After your proctectomy, you will need to stay in the hospital for around one week, if you experience no complications. You may receive restrictions on diet and physical activity following your procedure, as well as medication to treat any pain. If you have a stoma, you will also be given instructions on how to care for it. Full recovery may take up to six weeks.

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