Gastroenterology & Hepatology: Open Access Early Outcome of Laparoscopic Abdomino-Perineal Resection (Apr) in Low Rectal and Anal Cancer Volume 2 Issue 3 - 2015 Rayhanur Rahman 1 *, Shahadot Hossain Sheikh 2 , Rashidul Islam 2 , Ismat Jahan Lima 2 , Ariful Alam 2 Gazi Muhammad Salahuddin 2 and Tariq Akhtar Khan 2 1 Pabna Medical College, Bangladesh 2 Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Bangladesh *Corresponding author: Rayhanur Rahman, Assistant Professor of Surgery, Pabna Medical College, Pabna, Bangladesh, Tel: 01711284791; Email: Received: August 3, 2014 | Published: September 8, 2015 Abstract Background: Colorectal cancer is the second most common malignancy in the western countries and the rectum is the most frequent site involved. Carcinoma in the lower part of the rectum involving anal canal especially sphincter or purely in the anal canal is now successfully managed by laparoscopic APR and postoperative morbidities are less and recovery is uneventful. In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as equivalent to conventional open surgery in oncologic clearance. The advantages of laparoscopic surgery are smaller incisions, shorter recovery time and less wound related complications. However the narrow confines and angulations of the bony pelvis and the standard practice of autonomic nerve sparing total mesorectum excision has made laparoscopic surgery in the setting of rectal cancer more challenging. Methods: This randomized controlled trial study was carried out in the Colorectal Surgery Unit, Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from May, 2012 to April, 2013. 25 patients were treated by conventional open APR and rest 25 patients were treated by laparoscopic APR. All Patients of two groups were selected by simple random method (lottery). Early outcome variables after surgery were evaluated. Results: During early post-operative follow up, abdominal surgical site infection was found more in conventional open APR patients than that of laparoscopic APR patients (p<0.05). Other morbidity and colostomy related complications were not significant in early post-operative period in both groups of population. Degree of pain was also less after laparoscopic APR. Only stoma function occurred earlier after Laparoscopic APR and ambulation, feeding liquid and feeding solid all had no difference for both group. Shorter mean length of postoperative total hospital stay and early hospital discharge was possible after Laparoscopic APR. Oncologic parameters were equivalent to those of open procedures. Conclusion: The patients undergoing laparoscopic APR surgery had overall superior outcomes in term of surgical site infection, postoperative pain, postoperative total hospital stay and had equivalent oncologic clearance than those of open procedures in low rectal and anal cancer. Keywords: Early outcome; Low rectal and anal canal cancer; Laparoscopic abdomino-perineal resection Submit Manuscript | http://medcraveonline.com Gastroenterol Hepatol Open Access 2015, 2(5): 00056 Introduction Colorectal cancer is the second most common malignancy in the western countries and the rectum is the most frequent site involved. Carcinoma in the lower part of the rectum involving anal canal especially sphincter or purely in the anal canal is now successfully managed by laparoscopic APR and postoperative morbidities are less and recovery is uneventful. In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as equivalent to conventional open surgery in oncologic clearance. The advantages of laparoscopic surgery are smaller incisions, shorter recovery time and less wound related complications. However the narrow confines and angulations of the bony pelvis and the standard practice of autonomic nerve sparing total mesorectum excision has made laparoscopic surgery in the setting of rectal cancer more challenging [1]. Aim and objectives This study was done to compare the early outcomes of laparoscopic APR surgery with that of open APR surgery in low rectal and anal cancer patients in term of incidence of surgical site infections, degree of postoperative pain by visual analogue scale, days of recovery of bowel function, postoperative total hospital stay time and margin clearance of tumor. Materials and Methods This randomized controlled trial study was carried out in the Colorectal Surgery Unit, Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from May, 2012 to April, 2013. 25 patients were treated by conventional open APR and rest 25 patients were treated by laparoscopic APR. All Patients of two groups were selected by simple random method (lottery). Early outcome variables after surgery were evaluated. Research Article