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What Is Abdominoperineal Resection?

Abdominoperineal resection is major colorectal surgery that removes the rectum, anus, and anal sphincter complex. The operation is commonly used for very low rectal cancers when the sphincters cannot be safely preserved. Because the anus is removed, the colon is brought through the abdominal wall to create a permanent end colostomy. The procedure combines abdominal or pelvic dissection with a perineal phase to remove the specimen.

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What Is Abdominoperineal Resection?

Abdominoperineal resection is major colorectal surgery that removes the rectum, anus, and anal sphincter complex. The operation is commonly used for very low rectal cancers when the sphincters cannot be safely preserved. Because the anus is removed, the colon is brought through the abdominal wall to create a permanent end colostomy. The procedure combines abdominal or pelvic dissection with a perineal phase to remove the specimen.

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Why Is Abdominoperineal Resection Performed?

The procedure is most commonly performed for low rectal cancer when achieving adequate cancer clearance would require removal of the anal sphincters. It can also be used for selected anal cancers that persist or recur after chemoradiation and for certain severe benign diseases. Tumor level, sphincter involvement, pelvic anatomy, prior treatment, and expected bowel function influence whether sphincter-preserving surgery is feasible. The goal is complete disease removal when a safe and functional anastomosis cannot be created.

How Is Abdominoperineal Resection Performed?

The surgeon mobilizes the colon and rectum through an open, laparoscopic, or robotic abdominal approach while following oncologic planes in the pelvis. The lower rectum, anus, and sphincter muscles are then removed through a perineal incision. The remaining colon is brought through the abdominal wall and matured as a permanent colostomy. The pelvic and perineal wounds are closed directly or reconstructed with mesh or flap tissue when a larger defect requires additional support.

What Is Recovery Like After Abdominoperineal Resection?

Recovery includes pain control, return of bowel function, wound care, walking, nutrition, and prevention of blood clots. A wound and ostomy nurse teaches colostomy care, appliance fitting, skin protection, and daily management before discharge. The perineal wound can take longer to heal than the abdominal incisions, particularly after radiation therapy. Long-term follow-up addresses stoma function, urinary and sexual health, cancer surveillance, and any ongoing pelvic or wound symptoms.

What Are the Risks and Complications?

Possible complications include bleeding, infection, pelvic abscess, bowel obstruction, blood clots, urinary problems, and sexual dysfunction. Perineal wound infection, separation, delayed healing, chronic sinus formation, and perineal hernia are recognized concerns after this operation. Colostomy complications can include skin irritation, prolapse, retraction, narrowing, or parastomal hernia. Injury to pelvic nerves or nearby organs can also affect bladder, sexual, or bowel function.

Frequently Asked Questions About Abdominoperineal Resection

Does abdominoperineal resection always require a permanent colostomy?

Yes. Because the anus and sphincter complex are removed, stool can no longer leave through the natural anal opening. A permanent end colostomy provides the new route for bowel movements.

Is APR the same as a low anterior resection?

No. Low anterior resection preserves the anus and creates a bowel connection, while APR removes the anus and requires a permanent colostomy.

Why can the perineal wound heal slowly after APR?

The operation leaves a deep pelvic and perineal wound, and prior radiation can impair tissue healing. Infection, fluid collections, diabetes, smoking, and other factors can also delay recovery.

Can abdominoperineal resection be performed minimally invasively?

Yes. The abdominal portion can be performed laparoscopically or robotically in selected patients, although a perineal incision is still required to remove the anus and lower rectum.

References

Lesser Metatarsal - Shortening Surgery for Pain Relief. FootCareMD, American Orthopaedic Foot & Ankle Society. https://www.footcaremd.org/foot-and-ankle-treatments/midfoot/lesser-metatarsal-shortening-osteotomy. Date Accessed August 13, 2026.

Complications of the Weil osteotomy. PubMed. https://pubmed.ncbi.nlm.nih.gov/21490179/. Date Accessed August 13, 2026.

Evolution of the Weil Osteotomy: The Triple Osteotomy. PubMed. https://pubmed.ncbi.nlm.nih.gov/31653365/. Date Accessed August 13, 2026.

Incidence of and Functional Significance of Floating Toe After Weil Osteotomy. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC8697231/. Date Accessed August 13, 2026.

Anatomic plantar plate repair using the Weil metatarsal osteotomy approach. PubMed. https://pubmed.ncbi.nlm.nih.gov/21421939/. Date Accessed August 13, 2026.