Procedure-Rectal

Procedure definition

“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 procedures are done for rectal cancer, but they can also treat large benign polyps, severe rectal prolapse, or inflammatory disease.

The three main types are:
• Low Anterior Resection (LAR): removes the upper or mid-rectum and connects the colon to the remaining rectum so stool continues through the anus.
• Abdominoperineal Resection (APR): removes the entire rectum and anus for very low cancers; the end of the colon is brought out through the abdomen as a permanent colostomy.
• Transanal or Local Excision (TAMIS/TEM): removes small early tumors through the anus without cutting through the abdomen.

Surgeons use laparoscopic, robotic, or open approaches depending on tumor size, location, and prior surgeries. Operations last 3–5 hours.

Why it’s done

The rectum sits deep in the pelvis and is a common site for adenocarcinoma. Curative surgery is the cornerstone of treatment and often paired with chemotherapy and radiation to shrink tumors before removal (neoadjuvant therapy).

Other reasons include:
• Benign villous adenomas that can’t be removed endoscopically.
• Severe rectal prolapse causing incontinence.
• Refractory ulcerative colitis with dysplasia.

Modern “total mesorectal excision (TME)” techniques precisely remove tissue around the rectum while protecting nearby nerves that control bladder and sexual function.

Risks & complications 

Rectal surgery is complex, but outcomes have improved with high-volume centers and minimally invasive methods.

Overall complication rate: 25–40%.
Mortality: 1–3% elective, higher for emergencies.

Key complications:
• Anastomotic leak: 5–15% (depends on tumor level; highest in low connections).
• Wound or pelvic infection: 10–20%.
• Bleeding requiring transfusion: 2–5%.
• Urinary retention or bladder dysfunction: 5–10%.
• Sexual dysfunction: 20–40% temporary; 10–20% may persist.
• Bowel irregularity (“LARS” syndrome): urgency or frequent stools in 30–50% after LAR.
• Stoma-related issues (if present): 10–20%.
• Venous thromboembolism: 1–3%.

Use of diverting temporary ileostomies, leak testing, and enhanced recovery programs has reduced major morbidity substantially.

Recovery

Hospital stay: 4–7 days (longer with open or complicated cases).

Early recovery: Patients start walking the day after surgery and begin a clear-liquid diet that advances as the bowel wakes up.
Pain: Controlled with oral or epidural medications.

Activity: Desk work in ~3 weeks; heavy lifting or sports after 6–8 weeks.
Bowel function: Irregularity (loose or clustered stools) is common for several months as the colon adapts. A low-fiber diet may help initially, then fiber is re-added gradually.
Stoma care: If a temporary or permanent ostomy is present, an enterostomal therapist teaches appliance management before discharge.

Long-term: Most patients resume normal activity and continence. Full recovery can take 8–12 weeks, with ongoing follow-up for cancer surveillance.

Surgeon types

Colorectal Surgeons perform rectal operations. They have specialized training in pelvic anatomy, minimally invasive methods, and nerve-sparing techniques. Outcomes are significantly better at high-volume colorectal centers that perform TME routinely and provide multidisciplinary cancer care.

Representative citations

1. American Society of Colon & Rectal Surgeons (ASCRS): “Rectal Cancer Surgery and TME.”
2. NCCN Guidelines (2023): Rectal cancer treatment algorithms.
3. Annals of Surgery (2019): Leak rate 8%, mortality 1.2%.
4. NIH MedlinePlus: “Rectal Surgery.”
5. JAMA Surgery (2021): Low Anterior Resection Syndrome outcomes.