A rectal resection is the surgical removal of a portion of the rectum.
Rectal resections repair damage to the rectum caused by diseases of the lower digestive tract, such as cancer, diverticulitis, and inflammatory bowel disease (ulcerative colitis and Crohn's disease). Injury, obstruction, and ischemia (compromised blood supply) may require rectal resection. Masses and scar tissue can grow within the rectum, causing blockages that prevent normal elimination of feces. Other diseases, such as diverticulitis and ulcerative colitis, can cause perforations in the rectum. Surgical removal of the damaged area can return normal rectal function.
Colorectal cancer affects 140,000 people annually, causing 60,000 deaths. Incidence of the disease in 2001 differed among ethnic groups, with Hispanics having 10.2 cases per 100,000 people and African Americans having 22.8 cases per 100,000. Rectal cancer incidence is a portion of the total colorectal incidence rate. Surgery is the optimal treatment for rectal cancer, resulting in cure in 45% of patients. Recurrence due to surgical failure is low, from 4–8%, when the procedure is meticulously performed.
Crohn's disease and ulcerative colitis, both chronic inflammatory diseases of the colon, each affect approximately 500,000 young adults. Surgery is recommended when medication fails patients with ulcerative colitis. Nearly three-fourths of all Crohn's patients will require surgery to remove a diseased section of the intestine or rectum.
During a rectal resection, the surgeon removes the diseased or perforated portion of the rectum. If the diseased or damaged section is not very large, the separated ends are reattached. Such a procedure is called rectal anastomosis.
A number of tests identify masses and perforations within the intestinal tract.
To cleanse the bowel, the patient may be placed on a restricted diet for several days before surgery, then placed
Postoperative care involves monitoring blood pressure, pulse, respiration, and temperature. Breathing tends to be shallow because of the effect of the anesthesia and the patient's reluctance to breathe deeply due to discomfort around the surgical incision. The patient is taught how to support the incision during deep breathing and coughing, and given pain medication as necessary. Fluid intake and output is measured, and the wound is observed for color and drainage.
Fluids and electrolytes are given intravenously until the patient's diet can be resumed, starting with liquids, then adding solids. The patient is helped out of bed the evening of the surgery and allowed to sit in a chair. Most patients are discharged in two to four days.
Rectal resection has potential risks similar those of other major surgeries. Complications usually occur while the patient is in the hospital and the patient's general health prior to surgery will be an indication of the risk potential. Patients with heart problems and stressed immune systems are of special concern. Both during and following the procedure, the physician and nursing staff will monitor the patient for:
Symptoms that the patient should report, especially after discharge, include:
Complete healing is expected without complications. The recovery rate varies, depending on the patient's overall health prior to surgery. Typically, full recovery takes six to eight weeks.
Mortality has decreased from nearly 28% to under 6%, through the use of prophylactic antibiotics before and after surgery.
If the section of the rectum to be removed is very large, the rectum may not be able to be reattached. Under those circumstances, a colostomy would be preformed. The distal end of the rectum would be closed and left to atrophy. The proximal end would be brought through an opening in the abdomen to create an opening, a stoma, for feces to be removed from the body.
Johnston, Lorraine. Colon & Rectal Cancer: A Comprehensive Guide for Patients and Families. Sebastopol, CA: O'Reilly, 2000.
Levin, Bernard. American Cancer Society Colorectal Cancer. New York: Villard, 1999.
Beets-Tan, R. G. H., et al. "Accuracy of Maganetic Resonance Imaging in Prediction of Tumour-free Resection Margin in Rectal Cancer Surgery." The Lancet 357 (February 17, 2001): 497.
Schwenk, Wolfgang. "Pulmonary Function Following Laparoscopic or Conventional Colorectal Resection: A Randomized Controlled Evaluation." Journal of the American Medical Association 281 (April 7, 1999): 1154.
Walling, Anne D. "Follow-up After Resection for Colorectal Cancer Saves Lives. (Tips from Other Journals)." American Family Physician 66 (August 1, 2002): 485.
American Board of Colon and Rectal Surgery (ABCRS). 20600 Eureka Road, Suite 713, Taylor, MI 48180. (734) 282-9400. http://www.fascrs.org .
Mayo Clinic. 200 First St. S.W., Rochester, MN 55905. (507) 284-2511. http://www.mayoclinic.org .
Rectal resections are performed by general surgeons and colorectal surgeons as in-patient surgeries under general anesthesia.