Laparoscopic Anterior Resection

Dr. Sulaiman Bin Yusof

MbChB (Sheffield) M.Med (Surg) FRCSEd (Gen Surg)
蘇萊曼·尤索夫博士

What Is Laparoscopic Anterior Resection?

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.

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.

Indications for Laparoscopic Anterior Resection

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 procedure removes the cancerous tissue while preserving as much of the rectum as possible to maintain normal bowel function.

Diverticular Disease

This procedure removes the affected portion of the colon, reducing the risk of further issues in cases of recurrent inflammation (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.

Benign Polyps

Large polyps that cannot be safely removed via colonoscopy or risk of becoming cancerous may require laparoscopic anterior resection as it allows for precise removal while preserving healthy bowel tissue.

Bowel Obstruction

When a blockage in the lower colon caused by scarring, tumours, or other conditions needs to be surgically addressed, this procedure can remove the obstructed section and restore normal bowel function.

Benefits of Laparoscopic Anterior Resection

Laparoscopic anterior resection offers several advantages over traditional open surgery, including:

Smaller Incisions

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.

Faster Recovery

The minimally invasive procedure allows for a faster recovery, enabling patients to resume normal routines sooner than with open surgery.

Reduced 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 procedure.

Lower Risk of Complications

With less manipulation of internal organs, there is a reduced risk of complications such as infections, adhesions (scar tissue that can cause pain or bowel obstruction), and hernias.

Improved Post-operative Mobility

Smaller incisions cause less pain, enabling patients to move around more easily after surgery, which helps prevent blood clots and accelerates recovery.

Preparation for Surgery

Proper preparation is necessary for a successful laparoscopic anterior resection, which typically involves the following:

Preoperative Assessment: The patient will undergo a thorough medical evaluation, including blood tests, imaging studies (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 procedure.

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 (inhaling food or liquid into the lungs).

Step-by-Step Procedure

A laparoscopic anterior resection involves the following steps:

Anaesthesia

The patient is placed under general anaesthesia, ensuring they are asleep and pain-free during the surgery. Anaesthesia is administered by an anaesthetist, who also monitors the patient’s vital signs throughout the procedure.

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.

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Post-Surgical Care and Recovery

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 (IV) line and vital signs are closely tracked. Patients start on IV 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.

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Dr. Sulaiman Bin Yusof

MbChB (Sheffield)

M.Med (Surgery)

FRCSEd (General Surgery)

蘇萊曼·尤索夫博士

Dr. Sulaiman Yusof is a distinguished Senior Consultant in colorectal and general surgery, boasting over 15 years of expertise. His passion lies in minimally invasive techniques, particularly robotic surgery, where he has achieved remarkable success using the Da Vinci Xi system. Dr. Sulaiman is dedicated to delivering high-quality, personalized, and empathetic care, always striving for the best outcomes for his patients.

Education & Specialist Training
  • MbChB(Sheffield)
  • M.Med(Surgery)
  • FRCSEd(General Surgery)

Dr. Sulaiman’s journey began at the University of Sheffield, where he graduated in 2002. He honed his skills during his house officer and basic surgical training in the UK before returning to Singapore. There, he completed his Advanced Surgical Training at Changi General Hospital and earned the Joint Speciality Fellowship in General Surgery in 2013.

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    Frequently Asked Questions

    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 return to work after surgery?

    Most patients can return to light work within 2 to 4 weeks, depending on their recovery and the nature of their job. It is best to follow your surgeon’s advice on when to resume work.

    Will I need a stoma, and is it permanent?

    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 complications after surgery?

    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.

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