Rectal Surgery

What Is Rectal Surgery?

Rectal surgery is a broad term covering several operations to remove or repair part of the rectum, the final segment of the large intestine. Most commonly performed for rectal cancer, though it also treats benign polyps, prolapse, and inflammatory disease.

Three main types:

• Low Anterior Resection (LAR): Removes upper/mid-rectum; reconnects colon to remaining rectum.
• Abdominoperineal Resection (APR): Complete rectum and anus removal; creates permanent colostomy.
• Transanal Excision: Removes small early tumors through the anus without abdominal incision.

Operations can be performed via laparoscopic, robotic, or open methods and typically last 3-5 hours.

Why It's Done

• Rectal adenocarcinoma treatment (primary indication)
• Benign villous adenomas unsuitable for endoscopic removal
• Severe rectal prolapse with incontinence
• Refractory ulcerative colitis with dysplasia

Risks & Complications

Overall complication rates range from 25-40%, with mortality for elective cases at 1-3%.

• Anastomotic leak: 5-15%
• Infection: 10-20%
• Transfusion-requiring bleeding: 2-5%
• Urinary dysfunction: 5-10%
• Sexual dysfunction: 20-40% temporary; 10-20% persistent
• Bowel irregularity (LARS): 30-50%
• Stoma-related issues: 10-20%
• Venous thromboembolism: 1-3%

Recovery Timeline

• Hospital stay: 4-7 days
• Early mobilization: Day after surgery
• Return to desk work: Approximately 3 weeks
• Full activity/heavy lifting: 6-8 weeks
• Complete recovery: 8-12 weeks

Surgeon Specialists

Colorectal Surgeons perform these operations. Outcomes significantly improve at high-volume colorectal centers that perform total mesorectal excision (TME) routinely and provide multidisciplinary cancer care.