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Laparoscopic Abdomino-Perineal excision of Rectum (APER)

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APER involves removal of your rectum, anus and the muscles that control your bowels. You will therefore need a permanent stoma. This is where part of your bowel is opened onto your tummy; you will need to wear a bag over the stoma.  It sounds awful, but believe me you will adapt and carry on with a normal life.  You will have three small wounds, two on the right hand side (5 & 12mm) and one through your tummy button (12mm).  The resected specimen is removed through your bottom.

Before Your Operation

  •  Routine tests will be carried out in pre-admission a week before surgery.
  • The stoma nurse will see you before the surgery to run through with you about the stoma and more importantly, she will mark the stoma site on your tummy.
  • You will be admitted on the day of surgery. You will probably be in hospital for a week.  Drink water up to the admission and surgery.  You may be given an enema.
  • Have nothing to eat or drink milk for the 6 hours prior to surgery. 
  • The ward nurses will fit you up with some below knee compression stockings to reduce the risk of you developing a deep vein thrombosis.
  • Dr Greenslade, consultant anaesthetist will visit you and discuss the anaesthetic and the methods of postoperative pain relief.
  • A ward nurse will take you to theatre.  Dr Greenslade will position you on the operating table in theatre before he puts you to sleep.  This reduces the risk of you getting back pain and a bed sore.
  • After your operation you will be taken to the recovery ward, where you will have your blood pressure and pulse monitored. When you are fully awake and comfortable you will be taken back to the ward.

On your return from theatre you may have the following:

  • A drip going into a vein in your arm to give you fluid and pain killers. 
  • You will be able to give yourself a shot of the pain killer as necessary.
  • Recently Dr Greenslade has started to prescribe patients oral morphine solution - it works very quickly.
  • A tube into your bladder to drain urine.
  • Three tiny dressings over the wounds on your tummy
  • A drain which passing through your tummy into your pelvis to remove any blood.
  • A clear bag over your stoma.
  • We will let you drink as soon as you feel thirsty.  We will also encourage you to eat something
  • The drips and drains will be removed after 24-48hrs.
  • You will be given oral soluble paracetamol for pain relief - it is very effective
  • The nurses will give you tiny injections under the skin to thin the blood and reduce the risk of you getting a blood clot.
  • The nurses will get you up and about the same evening as your surgery
  • The more mobile you are and the less morhine that you take, the quicker you will recover.
  • The stoma care nurse will visit you and show you how to care for your stoma. If you wish for a family member or friend to be present this can be arranged.
  • Lisa, our specialist cancer nurse will visit most days.


  • The risks of this operation are small and much less than the risk of doing nothing. However, it is still a very major operation and there is a mortality (less than 1%).  The risk depends on how fit you are should any complications develop.
  • Complications include; bleeding, chest and heart problems, infections and retention of urine. 
  • There is a risk of injury to the bladder and the pelvic nerves that affect sexual function (less than 50%)
  • Breakdown of the perineal wound (more common if you received preoperative radiotherapy/
  • We will discuss this further when you are asked to sign a consent form

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Contact: Claire Trenberth - 0117 9804051