Abdominoperineal Resection
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Abdominoperineal Resection
Long-term Complications of Abdominoperineal Resection: Strategies for Evaluation, Management, and Prevention
V-Y Gluteal Fasciocutaneous Advancement Flap after Robotic Abdominoperineal Resection
Benign Disease- A 65-year-old man with a history of rectal cancer underwent abdominoperineal resection 10 years ago. He presents with a large, symptomatic parastomal hernia. Which technique has the lowest recurrence rate?
- A 65-year-old woman with coronary artery disease and a history of abdominoperineal resection for a low rectal cancer 3 years ago presents with a painless peristomal bulge and an occasional appliance leak. She denies pain and reports normal colostomy output. Examination reveals a pink healthy colostomy and soft bulge medial to the stoma on application of the Valsalva maneuver. Result of recent surveillance computed tomography is available for review (Figure). What is the best management option?
- A 70-year-old man with history of perianal Crohn’s disease and 15-year history of an anal fistula presents to establish care. On examination, he has a right anterior anal fistula that appears chronic in nature. What is the best next step in management?
Benign Disease- A 34-year-old otherwise healthy woman, who underwent total abdominal colectomy with end ileostomy 1 year ago for fulminant Crohn’s disease colitis, presents to the office with ongoing bloody mucoid discharge per rectum and tenesmus. On examination, her abdomen is unremarkable with end ileostomy. Ileostomy is healthy and pouches well. Rectal examination is remarkable for normal perineal skin, normal tone, and absence of fistula and fissure. She has been through four different biologics. Endoscopy shows deep ulcers in the rectum with mucosal friability. She has bothersome mucoid anal discharge multiple times per day and wishes to know whether this can be resolved. Her small bowel disease was previously active and is now quiescent on entyvio. What is the best next option in her management?
- Five years after abdominoperineal resection (APR) for rectal cancer, a 57-year-old woman presents with bulging at the site of a left lower quadrant colostomy. She is concerned regarding her physical appearance and symptoms of rare fecal leakage at the appliance. The best initial treatment for this patient is
- Miscellaneous
- Miscellaneous
Locally Recurrent Rectal Cancer- Colorectal Cancer: Minimally Invasive Surgery
- Local Excision
- Sexual Function After Colorectal Surgery in Women
- Malignancy
- A 64-year-old woman with a history of cervical intraepithelial neoplasia presents with a firm 3-cm mass protruding at the anal verge. Anoscopy shows a fixed mass just distal to the dentate line. A biopsy of the lesion is performed, which has the findings shown in the Figure. Colonoscopy findings are unremarkable and computed tomography of the chest, abdomen, and pelvis reveals no evidence of distant disease. Magnetic resonance imaging reveals no locoregional nodal or sphincter involvement. The next best step in management for this patient is:
- A 63-year-old woman is diagnosed with a 1.5-cm, well-differentiated perianal squamous cell cancer that is 3.5 cm from the anal verge, with no involvement of the anal sphincter mechanism. There is no radiographic evidence of inguinal nodal or metastatic disease. The best treatment option for this patient is:
- A 50-year-old woman is found to have a 7-mm submucosal yellow lesion in the distal rectum on screening colonoscopy. There is no pillow sign. What is the most likely diagnosis?
- A 65-year-old man was diagnosed with a 1.5-cm lesion at the anal verge. Biopsies were positive for S100 and HMB-45. Computed tomography of the chest, abdomen, and pelvis showed no metastases. Which is the next best step in this patient’s treatment?
- A 53-year-old man is diagnosed with rectal adenocarcinoma 7 cm from the anal verge. Preoperative pelvic magnetic resonance imaging (MRI) demonstrates a threatened circumferential radial margin. After total neoadjuvant chemoradiation, a repeat MRI demonstrates a persistently threatened radial margin. Which of the following adjuncts should be considered in operative planning for this patient?
- A 68-year-old man with a history of a hemorrhoidectomy and fecal urgency presents with a T3n1m0 rectal cancer 5 cm from the anal verge. He has no family history of colorectal cancer. What is the most important consideration when counseling the patient about his surgical treatment options?
- Parastomal and Perineal Hernias
- Proctectomy for Rectal Cancer
- Rationale for Multimodality Therapy
- Rectourethral and Complex Fistulas: Evaluation and Management
- Colorectal Cancer: Postoperative Adjuvant Therapy and Surveillance
- Anal Cancer
- Colorectal Cancer: Preoperative Evaluation and Staging
- Male Genitourinary Dysfunction as a Consequence of Colorectal Surgery
- Indications for LAR Versus Intersphincteric Resection Versus APR
- Gastrointestinal Stromal Tumors, Neuroendocrine Tumors, and Lymphoma
- Colorectal Cancer: Management of Distant Metastases
- Malignancy
- A 67-year-old man with anal cancer involving anterior rectal wall and dentate line and prostate, staged T4N1aM0, had undergone chemoradiation and presents for evaluation 8 weeks after therapy completion. He reports that discomfort is nearly gone from the anal canal and that his bowel movements are normal. On examination, there is a shallow 1-cm ulcer. What is the best next option?
- A 56-year-old obese man with locally advanced distal rectal cancer is treated with total neoadjuvant chemoradiation therapy. His is a 45-pack-per-year smoker. Restaging reveals no sign of metastasis. Magnetic resonance imaging (MRI) rectal protocol reveals partial clinical response and flexible sigmoidsociopy that shows a 3-cm tumor involving the sphincteric complex. What is the best surgical approach in his care?
- A 47-year-old woman presents with rectal pain and feculent discharge from her vagina. A digital rectal exam (DRE) in the office reveals a 4-cm, firm, palpable mass starting just below the dentate line; it is immobile and contiguous with the posterior vaginal wall. You perform a biopsy that confirms squamous cell carcinoma. After completing the staging workup, you find she has T4N0, stage IIIB disease. The recommended treatment is
- A 57-year-old man undergoes total neoadjuvant therapy (TNT) for management of a cT3N1M0 rectal cancer. After completion of both chemotherapy/radiotherapy and consolidation chemotherapy, the presence of complete clinical response to treatment is assessed by
- During screening colonoscopy, a 0.9-cm rectal polyp was removed using a saline lift snare polypectomy. Pathology was significant for well-differentiated submucosal neuroendocrine tumor without lymphovascular involvement or penetration into the muscularis propria. What is the best next step in management?
- Bowel Dysfunction Low Anterior Resection Syndrome
- Standardized Operative Report
- Sexually Transmitted Infections of the Colon and Rectum
- Anal Squamous Cell Cancers (Revised 2018)
- Anal Fissure and Anal Stenosis
- Perioperative
- Enhanced Recovery After Colon and Rectal Surgery from ASCRS and SAGES (2023)
- Anatomy and Embryology of the Colon, Rectum, and Anus
- Management of Rectal Cancer (2020)
- General Postoperative Complications
- Indications for Extended Resection
- Anorectal Disease
- Management of Local Recurrences
- Rectovaginal Fistula
- Bowel Transection and Anastomosis
- Sexual Dysfunction and Its Management
- Surgical Management of Crohn's Disease (2020)
- ASCRS Webinars
- Management of Intraoperative Vascular and Urinary Complications
- Patient Positioning and Equipment for Rectal Cancer Surgery
- Treatment of Chronic Radiation Proctitis (2018)
- Anastomotic Complications
- Ostomy Surgery (2022)
- Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula (2022)