Rectal Resection and Suturing: Risks and Recovery Insights

Rectal resection and anastomosis?

Hello Dr.
Zhang, in August, I underwent a colonoscopy at a certain hospital, and the biopsy results indicated the presence of an adenomatous polyp.
Due to the large size of the polyp and its benign nature, the physician who examined me determined that endoscopic submucosal dissection (ESD) could be performed for treatment.
He did not inform me of any alternative options until just before the surgery, believing that ESD would not damage the muscular layer, which made me feel reassured as I entered the operating room.
However, during the procedure, the doctor encountered unexpected bleeding that affected the endoscopic view, leading to a sudden change in the surgical plan.
Instead, he directly excised a segment of approximately 3 centimeters of the rectum and then performed suturing (the family was informed of this change only after the surgery, and consent was not obtained at that time).
The excised portion was only 2 centimeters from the anal opening.
Although the doctor stated that the surgery was very successful and that there would be no complications aside from a potential narrowing of the anal canal, I find it hard to imagine how a rectal resection and suturing could be performed without an open abdominal approach, and I wonder if there truly will be no complications given the proximity to the anal opening.

Therefore, I would like to ask Dr.
Chen: Will there be scarring, irregularities, or areas that are particularly thin on the surface of the rectum after suturing? Is it possible for the sutured area to return to the original smooth surface of the rectum? Will there be a risk of the sutured area reopening in the future? Given the closeness to the anal opening, is it really true that there will be no complications? I am still very young, and the thought of having a rectum that is 3 centimeters shorter than normal for the next several decades, with a surface that might be uneven and the potential for tearing during vigorous activities, makes me feel very insecure.

QQ, 20~29 year old female. Ask Date: 2022/11/09

Dr. Zhang Shuhao reply Surgery

If the abdomen is not entered, a portion of the rectum can still be pulled through the anus for resection and anastomosis (referred to as pull-through; this method is sometimes used for rectal prolapse surgery).
The sutured area will heal over time, and there is no need to worry about it splitting open or the intestinal wall being uneven.
However, as the surgeon mentioned, the main concern is the potential for scar tissue to cause stricture, poor healing, and issues affecting bowel function.
Postoperatively, it is important to monitor bowel movements and follow up in the outpatient clinic for wound assessment.

Reply Date: 2022/11/09

More Info

Hello, thank you for sharing your concerns regarding the rectal resection and suturing procedure you underwent. It’s understandable to have questions and worries after such a significant surgical intervention, especially when it involves a sensitive area like the rectum.

Firstly, it’s important to acknowledge that rectal resections, even when performed minimally invasively, carry inherent risks and potential complications. The fact that your procedure was altered from a less invasive technique to a resection indicates that the surgical team had to make a critical decision based on the circumstances encountered during the procedure. While it’s common practice to inform patients of potential risks and alternative options prior to surgery, unexpected situations can arise that necessitate immediate changes to the surgical plan.

Regarding your specific concerns:
1. Healing and Scarring: After a rectal resection, the area where the tissue was removed will heal, but it may not return to its original state. The sutured area may have some degree of scarring, which can lead to a change in texture. However, the body is quite adept at healing, and many patients find that the area becomes less noticeable over time. The rectal lining is resilient, and while there may be some irregularities, it typically does not lead to significant functional issues.

2. Risks of Complications: There is always a risk of complications such as anastomotic leakage (where the sutured area does not heal properly), strictures (narrowing of the rectum), or even infection. The proximity of the resection to the anus does increase the risk of certain complications, but many patients do not experience significant long-term issues. Regular follow-ups with your healthcare provider will be crucial to monitor your recovery and address any concerns early on.

3. Long-term Effects: While it’s natural to worry about the long-term implications of having a shorter rectum, many individuals live normal, healthy lives after similar procedures. The body often compensates for such changes, and with proper care, most patients do not experience significant limitations. Engaging in regular follow-up care and discussing any concerns with your healthcare provider can help alleviate worries about future complications.

4. Activity and Lifestyle: After recovery, you should be able to return to most of your normal activities, including exercise. However, it’s advisable to avoid high-impact activities until you have fully healed and received clearance from your doctor. They can provide personalized advice based on your recovery progress.

5. Psychological Impact: It’s also important to consider the emotional and psychological aspects of recovery. It’s normal to feel anxious about changes to your body and potential complications. Seeking support from a mental health professional or joining a support group for individuals who have undergone similar surgeries can be beneficial.

In conclusion, while there are risks associated with rectal resection, many patients recover well and lead fulfilling lives post-surgery. It’s essential to maintain open communication with your healthcare team, adhere to follow-up appointments, and voice any concerns you may have. They can provide reassurance and guidance tailored to your specific situation. Remember, you are not alone in this journey, and support is available to help you through your recovery.

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