Name of the Procedure:

Proctectomy, Combined Abdominoperineal, Pull-Through Procedure (Colo-Anal Anastomosis)

Summary

A proctectomy combined with abdominoperineal pull-through, commonly known as colo-anal anastomosis surgery, is a procedure that involves the removal of part of the rectum and the colon, followed by a reconstruction to connect the remaining colon directly to the anus.

Purpose

The procedure is typically performed to treat conditions such as colorectal cancer, inflammatory bowel disease, or severe trauma to the rectum. The goal is to remove diseased tissue while maintaining the patient's ability to pass stools normally.

Indications

• Colorectal cancer
• Ulcerative colitis or Crohn's disease affecting the rectum
• Severe, non-healing trauma to the rectum
• Chronic rectal bleeding that hasn’t responded to other treatments

Preparation

Patients may be instructed to:

• Fast for 12 hours prior to surgery.
• Undergo a bowel prep to clean out the intestines.
• Stop certain medications as advised by their doctor.

• Complete pre-operative blood tests and imaging studies like colonoscopy or CT scans.

  Procedure Description

  1. Anesthesia: General anesthesia is administered.
  2. Abdominal Phase: An incision is made in the abdomen to access and remove the diseased section of the colon and rectum.
  3. Perineal Phase: An incision is made in the area around the anus to remove the remaining rectal tissue.
  4. Reconstruction: The surgeon pulls the remaining part of the colon down and creates an anastomosis (connection) to the anus.
  5. Closure: Both abdominal and perineal incisions are closed with sutures or staples.

Tools and equipment such as surgical staplers, retractors, and laparoscopic instruments may be used during the procedure.

Duration

The procedure typically takes 3 to 5 hours.

Setting

It is performed in a hospital operating room.

Personnel

• Surgeons (colorectal surgeon and possibly a general surgeon)
• Anesthesiologists
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Anastomotic leak (where the new connection between the colon and anus doesn’t heal properly)
• Injury to surrounding organs
• Prolonged bowel dysfunction

Benefits

The primary benefit is the removal of diseased tissue, which can improve symptoms, prevent further disease progression, and potentially cure certain conditions like colorectal cancer. Most patients begin to see benefits within weeks, but full recovery can take several months.

Recovery

Post-procedure care involves:

• Pain management with medications
• Gradually reintroducing a soft diet
• Instructions for wound care and hygiene
• Physical activity restrictions for a few weeks
• Follow-up appointments for progress evaluation

Alternatives

• Total proctocolectomy with ileostomy
• Laparoscopic surgery for less extensive disease
• Chemotherapy or radiation therapy for cancer

These alternatives may have different benefits and risks. For example, an ileostomy eliminates the need for an anastomosis but requires a permanent external bag for waste.

Patient Experience

Patients will likely experience some discomfort and pain post-surgery, which can be managed with medications. Recovery involves hospital stay for a few days, and initial bowel movements may be irregular. Detailed guidance and support are provided to handle all post-operative challenges effectively.