A total mesorectal excision, also known as low anterior resection, is a common procedure used in the treatment of colorectal cancer in which a significant length of the bowel around the tumor is removed. Dr Heyns will generally choose a laparoscopic approach using keyhole techniques when possible as this approach is minimally invasive.
A total mesorectal excision is usually done for tumours located in the middle and the lower rectum (adenocarcinomas), to remove the rectum and sigmoid colon including the blood supply and associated lymph glands. A total mesorectal excision is now considered the gold standard for tumors of the middle and the lower rectum
This surgery is performed under general anaesthesia using laparoscopic techniques when possible. By making a few small incisions, a laparoscope can be inserted. With a camera and light at the end of it, this tool can be used to view the bowels internally, aiding surgery. While watching the video on a monitor, Dr Heyns can insert small surgical tools and remove the diseased rectum and part of the colon above it.
The fatty tissue that carries the blood vessels and lymph drainage to the bowel are also removed along with the nearby lymph nodes. The remaining ends of the bowel are then joined together. If the ends cannot be reattached, a colostomy will be performed. A colostomy is done by creating an opening in the abdomen, called a stoma, so that the colon can be connected. Waste can then pass through the stoma to the outside of the body to a pouch where it can collect and be removed.
Some pain and discomfort can be expected after a major surgery such as this. Pain relieving medications will be prescribed by Dr Heyns to make you comfortable and you will need to stay in hospital for the next week for observation. After surgery a dietician will discuss the necessary dietary restrictions and care instructions with you for your colostomy and stoma. Once discharged you will need to rest and refrain from any heavy lifting for the next few weeks.
The images & video below show what a total mesorectal excision involves & how it is done