Laparoscopic anterior resection in Singapore
Laparoscopic anterior resection removes the diseased section and rejoins the bowel.
Anterior resection removes a portion of the rectum or the lower colon and rejoins the healthy ends of the bowel in the same operation. Done laparoscopically it is reached through several cuts of about a centimetre rather than one long opening, which is why most patients are back to light activity in 2 to 4 weeks. Laparoscopic colectomy is the umbrella term for keyhole removal of part of the colon; anterior resection is the version for the rectum and lower colon.
FRCSEd (General Surgery)Five clinics in Singapore
In short
Keyhole
How it is done
Small abdominal incisions admit a laparoscope, a thin flexible tube with a camera, and the surgical instruments, instead of one long opening.
Rejoined
In the same operation
The diseased portion of the rectum or the lower colon is removed and the healthy ends of the bowel are reconnected during the same surgery.
2 to 4
Weeks to light activity
Most patients can begin light activities within 2 to 4 weeks. Full recovery, and the return to normal routines, typically occurs within 4 to 6 weeks.
Claimable
Insurance and corporate plans
For Singaporeans, Singapore Permanent Residents and foreigners. Please speak to our clinic staff about using your insurance plans.
His story
Dr Sulaiman Bin Yusof
Senior Consultant Colorectal and General Surgeon, seeing patients at five clinics in Singapore.
- MBChB (Sheffield), M.Med (Surgery), FRCSEd (General Surgery)
- Consults in English and Malay
- MOH Fellowship, Peter MacCallum Cancer Centre, Melbourne
- Singapore Health Quality Service Star Award 2023
- Dean's Honour Roll for Teaching
What the operation involves
What the operation involves
0.5 to 1 cm
Length of each incision
Source: Dr Sulaiman Bin Yusof, clinical practice
Asleep
General anaesthesia, monitored throughout
Small incisions
Entry points for the camera and instruments
The diseased section out
Nerves and blood vessels preserved
The bowel rejoined
Healthy ends reconnected, then closed
2 to 4
Hours in theatre
Source: Dr Sulaiman Bin Yusof, clinical practice
What it is
Removing a section of the rectum or lower colon, through small cuts.
Laparoscopic anterior resection is a minimally invasive surgery that removes a portion of the rectum or the lower colon to treat rectal cancer, diverticular disease, or benign polyps that cannot be removed through less invasive methods. Where the diagnosis is rectal cancer and the robotic platform fits the case, robotic rectal cancer surgery is described on its own page.
Small abdominal incisions allow the insertion of a laparoscope, a thin, flexible tube with a camera, and other surgical instruments. The laparoscope provides the surgeon with a detailed view of the internal organs, allowing for precise removal of the diseased tissue while preserving as much healthy bowel as possible.
Where the segment that has to come out lies further up the colon rather than in the rectum or the lower colon, the operation is a laparoscopic hemicolectomy instead, another form of laparoscopic colectomy.
Robotic-assisted technique is Dr Sulaiman’s primary surgical platform for colectomy and anterior resection, and what the robotic version of this operation involves is set out on the robotic colectomy and anterior resection page.
When it is needed
Five reasons this operation gets recommended.
Indications for laparoscopic anterior resection include the following conditions.
Rectal cancer
Particularly when the cancer is located in the upper or middle third of the rectum, this operation removes the cancerous tissue while preserving as much of the rectum as possible to maintain normal bowel function.
Diverticular disease
This operation removes the affected portion of the colon, reducing the risk of further issues in cases of recurrent inflammation, or diverticulitis, leading to complications such as abscesses, fistulas, or strictures.
Inflammatory bowel disease
For Crohn's disease or ulcerative colitis patients, surgery may be required when medication fails to control the symptoms or when complications such as strictures or fistulas occur.
Large or high-risk polyps
Large polyps that cannot be safely removed via colonoscopy, or that are at risk of becoming cancerous, may require laparoscopic anterior resection as it allows for precise removal while preserving healthy bowel tissue.
A blockage of the lower colon
When a blockage in the lower colon caused by scarring, tumours, or other conditions needs to be surgically addressed, this operation can remove the obstructed section and restore normal bowel function.
Where the indication is cancer, how it is diagnosed and staged before any operation is planned is set out on the colorectal cancer page. Where it is recurrent inflammation, how the disease behaves before surgery is considered is on the diverticulitis page.
The two forms of inflammatory bowel disease have a page each: Crohn’s disease and ulcerative colitis.
What a polyp is, and why some can be removed during a camera test while others cannot, is on the colon polyps page. A blockage of the lower bowel is covered on the large bowel obstruction page.
Why keyhole
What the keyhole approach changes, compared with open surgery.
Laparoscopic anterior resection offers several advantages over traditional open surgery, including the following.
Smaller incisions, less trauma
The use of small incisions reduces trauma to the body, resulting in less postoperative pain, smaller scars, and a quicker healing process, lowering the risk of wound infection.
A faster return to normal routines
The minimally invasive operation allows for a faster recovery, enabling patients to resume normal routines sooner than with open surgery.
Less blood loss
Because laparoscopic surgery provides a clearer view of the surgical area, the surgeon is able to cut and seal blood vessels more efficiently. This precision reduces blood loss during the operation.
A lower risk of complications
With less manipulation of internal organs, there is a reduced risk of complications such as infections, adhesions, which is scar tissue that can cause pain or bowel obstruction, and hernias.
Moving sooner afterwards
Smaller incisions cause less pain, enabling patients to move around more easily after surgery, which helps prevent blood clots and accelerates recovery.
Two of the complications named above have pages of their own. Scar tissue forming inside the abdomen after surgery is covered on the intra-abdominal adhesions page, and repair of a hernia at or near an incision is covered on the keyhole hernia repair page.
Preparing
Most of the preparation happens before you arrive.
Proper preparation is necessary for a successful laparoscopic anterior resection, and it typically involves the following.
Preoperative assessment
The patient will undergo a thorough medical evaluation, including blood tests, imaging studies such as CT scans or MRIs, and possibly a colonoscopy to assess the extent of the disease, plan the surgery, and ensure the patient's overall health allows them to undergo surgery safely.
Bowel preparation
Patients must follow a special diet and take laxatives or enemas the day before surgery to empty the colon. This helps reduce the risk of infection and improves visibility during the operation.
Medication adjustment
Some medications, such as blood thinners, may need to be temporarily discontinued before surgery to reduce the risk of bleeding.
Fasting
Patients must fast for several hours before the surgery, typically starting the night before. Fasting reduces the risk of anaesthesia-related complications, such as aspiration, which means inhaling food or liquid into the lungs.
What the camera test itself involves, and what the day looks like, is on the colonoscopy page.
The operation
What actually happens once you are asleep.
A laparoscopic anterior resection involves the following steps, and they run in the same order every time.
Anaesthesia
The patient is placed under general anaesthesia, so they are asleep and unaware for the whole operation. Anaesthesia is administered by an anaesthetist, who also monitors the patient's vital signs throughout.
Incisions
The surgeon makes several small incisions in the abdomen, ranging from 0.5 to 1 cm in length. These serve as entry points for the laparoscope and surgical instruments. The number and placement of the incisions depend on the area of the bowel being operated on.
Laparoscope insertion
A laparoscope is inserted through an incision, providing the surgeon with a magnified, high-definition view of the abdomen on a monitor. This allows for precise dissection and tissue manipulation.
Pneumoperitoneum creation
Carbon dioxide gas is used to inflate the abdomen, creating a working space that allows the surgeon to see and move instruments more easily. This inflation helps lift the abdominal wall away from the organs, providing a clearer view and more room to operate.
Removal of diseased tissue
Specialised instruments are inserted through the other incisions to carefully detach and remove the diseased section of the rectum or colon while preserving nearby nerves and blood vessels to maintain bowel function and avoid complications.
Anastomosis
The healthy ends of the bowel are reconnected, a process called anastomosis, using sutures or surgical staples to restore the continuity of the digestive tract. The surgeon ensures there are no signs of leakage or tension at the anastomosis site to ensure proper healing.
Closure
The incisions are closed with sutures or surgical staples, and the wound is dressed. The laparoscope is removed, and the carbon dioxide gas is released from the abdomen before the final incision is closed.
Afterwards
Recovery, week by week, and when to call.
Immediate care
After surgery, the patient is moved to a recovery room and monitored as they awaken from anaesthesia. Pain is managed with medications provided orally or via an intravenous line, and vital signs are closely tracked.
Patients start on intravenous fluids and gradually transition to solid foods as bowel function returns, typically within a few days. Early movement is encouraged to prevent complications such as blood clots and speed up healing.
Recovery timeline
In the first week, patients gradually regain bowel function and start moving more easily. Physical activity is limited initially, but most patients can begin light activities within 2 to 4 weeks, depending on their recovery.
Full recovery, with the return to normal routines, typically occurs within 4 to 6 weeks, but this can vary based on the complexity of the surgery.
4 to 6
Weeks to full recovery
Source: Dr Sulaiman Bin Yusof, clinical practice
Recovery milestones, on a ten-week scale
- Light activity
- 2 to 4 weeks
- Full recovery
- 4 to 6 weeks
Source: Dr Sulaiman Bin Yusof, clinical practice
Cost and cover
The typical bill, and what Medisave and insurance cover.
MOH's transacted bill data puts the median private-hospital inpatient bill for a minimally invasive anterior resection at $58,411 including GST, with the middle half of bills between $50,423 and $68,084, before Medisave and insurance payouts.
Fees at the higher end tend to involve recurrent surgery, adhesions or more complex cases such as larger tumours invading surrounding structures, so read the benchmark as a reference point rather than a quote. The operation is Medisave-claimable, Integrated Shield Plans and corporate insurance are accepted at the clinics, and the clinic team will walk you through the estimate for your own operation at the specialist consultation.
Common questions
The questions that come up before an anterior resection.
How long does the surgery take?
A laparoscopic anterior resection typically takes 2 to 4 hours, depending on the complexity of the case.
When can I go back to work?
Most patients can return to light work within 2 to 4 weeks, depending on their recovery and the nature of their job. Follow your surgeon's advice on when to resume work.
Will I need a stoma?
A stoma may be needed temporarily, especially when surgery involves the lower rectum. In most cases, it can be reversed after a few months once healing is sufficient.
What are the signs of a complication?
Signs of complications include severe abdominal pain, fever, redness or swelling at the incision sites, or unusual bowel habits. Contact your surgeon if you experience any of these symptoms.
Book a consultation
Bowel surgery is planned, not rushed. Start with an assessment.
Consult Dr Sulaiman for an assessment and a personalised treatment plan. He sees patients at Gleneagles Medical Centre, Mount Elizabeth Novena Hospital, Parkway East Hospital, Mount Alvernia Hospital and Farrer Park Medical Centre.