Our Summary

This research paper discusses a surgical technique used for patients who require a specific kind of rectum surgery (proctectomy) or the removal of a particular intestinal structure (ileoanal J-pouch), but who cannot be operated on from the front of the abdomen due to prior surgeries. This technique, called a prone en bloc sacrectomy, is an alternative approach that involves the patient lying face-down and the surgeon accessing the pelvis by removing parts of the sacrum and coccyx (the lower part of the spine). The researchers found that this method was safe and effective in patients who had previously undergone surgery in the pelvic area, provided that the surgeon was highly experienced and knowledgeable about the anatomy of the area. In the two patients they tested, both recovered without complications and had successful removal of the necessary tissues. They conclude that this method could be a useful option for a very specific group of patients who cannot safely undergo traditional abdomen-based surgery.

FAQs

  1. What is a prone en bloc sacrectomy and why is it used?
  2. How safe and effective is the prone en bloc sacrectomy procedure?
  3. Who are the patients that could benefit from this alternative surgical method?

Doctor’s Tip

A doctor may advise a patient undergoing a proctectomy to follow a high-fiber diet and stay hydrated to help promote regular bowel movements and prevent constipation. They may also recommend gentle exercises, such as walking, to aid in the recovery process and prevent complications such as blood clots. Additionally, they may suggest seeking support from a mental health professional or support group to help cope with the emotional aspects of undergoing such a significant surgery.

Suitable For

Patients who are typically recommended for a proctectomy are those who have conditions such as rectal cancer, inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease), familial adenomatous polyposis (FAP), or other severe colorectal disorders that require the removal of part or all of the rectum. These patients may have failed previous treatments such as medication or less invasive surgeries, or may have a high risk of developing complications or cancer if the affected tissue is not removed.

In the case of the research paper discussed above, patients who had previously undergone surgeries in the pelvic area and were not suitable candidates for traditional abdomen-based surgery were recommended for a prone en bloc sacrectomy. These patients may have had scarring or adhesions in the abdomen from prior surgeries, making it difficult for the surgeon to access the affected area safely. Additionally, patients who have complex pelvic anatomy or who are at high risk for complications during traditional surgery may also be recommended for this alternative approach.

It is important for patients who are considering a proctectomy to consult with their healthcare providers and specialists to determine the most appropriate treatment plan for their individual condition. Factors such as overall health, age, the extent of the disease, and previous surgeries will all be taken into account when deciding on the best course of action for each patient.

Timeline

Before proctectomy:

  • Patient is diagnosed with a condition that requires proctectomy, such as rectal cancer or inflammatory bowel disease.
  • Patient undergoes pre-operative evaluations, including imaging studies and blood tests.
  • Patient meets with their surgical team to discuss the procedure, potential risks, and post-operative care.
  • Patient may need to make lifestyle changes, such as adjusting their diet or stopping certain medications.
  • Patient may undergo a bowel preparation to clean out their intestines before surgery.

After proctectomy:

  • Patient is taken to the operating room and undergoes the proctectomy procedure, which involves removing all or part of the rectum.
  • Patient wakes up in the recovery room and is closely monitored for any complications.
  • Patient may experience pain and discomfort, which is managed with pain medications.
  • Patient may have a temporary colostomy or ileostomy to allow the remaining intestine to heal.
  • Patient begins a gradual recovery process, including physical therapy and dietary changes.
  • Patient follows up with their surgical team for post-operative care and monitoring.
  • Patient may need additional treatments, such as chemotherapy or radiation therapy, depending on the underlying condition.
  • Patient gradually resumes normal activities and adjusts to any changes in bowel function.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a proctectomy using the prone en bloc sacrectomy technique?

  2. How experienced is the surgeon in performing proctectomy using this alternative approach?

  3. What is the success rate of this surgical technique compared to traditional abdominal approaches for proctectomy?

  4. What is the expected recovery time and post-operative care following a proctectomy using the prone en bloc sacrectomy technique?

  5. Are there any specific lifestyle changes or dietary restrictions that I will need to follow after undergoing this type of surgery?

  6. Will I require any additional treatments or therapies following a proctectomy using this technique?

  7. How long will I need to stay in the hospital after the surgery, and what is the follow-up care plan?

  8. Are there any specific exercises or physical therapy that I should do to aid in my recovery after a proctectomy using this technique?

  9. What is the long-term outlook for patients who undergo a proctectomy using the prone en bloc sacrectomy technique?

  10. Are there any alternative treatment options or surgical approaches that I should consider for my specific condition?

Reference

Authors: Solomon MJ, Loizides S, Däster S, Austin KKS, Lee PJ. Journal: Colorectal Dis. 2020 Oct;22(10):1440-1444. doi: 10.1111/codi.15106. Epub 2020 May 24. PMID: 32359204