Total Mesorectal Excision Surgery for Rectal Cancer

Before Your Surgery - The anesthesiologist will meet with you and take your health history, if you have not previously given it to him or her. An IV will be started. Medications are given through the IV to help you relax and feel sleepy.

Your wait in the pre-op area will depend on the operating room schedule. When ready for surgery, they wheel you into the operating room, or as it is often called the OR. You may still be awake until you get there and see the surgical team preparing for your surgery. When the team is ready to begin your operation, the anesthesiologist will add drugs to your IV to put you to sleep.

A tube will be passed through your mouth and down your throat into your windpipe. This tube will keep your airway open during surgery to give you oxygen and to provide more anesthesia. A nasogastric tube is inserted through your nose to your stomach to drain off any extra liquids from the inside of your stomach.

To help prevent a bacterial infection, your skin in the area of the surgical site will be scrubbed with antibacterial solution and covered with a sterile cloth except for the surgical site. Protective stockings may be placed on your legs. These special stockings are designed to improve your blood circulation and stop blood clots from forming.

The TME Surgery - The surgeon will slowly cut about a 12-inch incision in a straight vertical line through the layers of tissue to open the abdomen. Once the abdominal cavity is open the surgeon will explore it fully to look for possible spread of the cancer to the liver, the lymph system, or other organs.

The surgeon carefully moves all the organs in the pelvis aside to expose the rectum. The surgeon then dissects out the section of the rectum that is affected by the tumor and the fatty mesorectal tissue that surrounds that part of the rectum. Great care is taken to reduce damage to the autonomic nerves that control urination and defecation.

Because part of the rectum has been taken out, the surgeon forms a new fecal holding area to perform the function of the removed rectal tissue. A section of the sigmoid colon is pulled down to form a colo-pouch. After everything heals, the patient usually is able to have normal bowel movements.

Next, the two cut ends of the rectum are joined together in what is called the anastomosis. Surgical staples are used to close the ends. These staples remain in the body permanently.

Temporary Loop Ileostomy - To give the rectum a rest and time to heal, the surgeon will perform a temporary loop ileostomy. This will drain and allow the stool to be removed from the body before it can come in contact with the surgical site of the rectum. This helps to stop infection and lets the rectal muscles and other tissues heal faster and have time to recover. After the rectum has healed, the ileostomy will be closed and the rectum will resume doing its job of eliminating stool.

The surgeon removes a 1-inch circle of skin from the right side of the abdomen and then makes an incision down to the ileum, a section of the small intestine. A piece of the ileum, 8-12 inches from the ileocecal valve, is brought to the skin surface. Next, a matching circular incision is made in the ileum. Then the skin and the ileal wall are sewn together to form a stoma. The ileostomy is temporary. Usually the ileostomy is closed about six weeks after rectal surgery, when the rectum has healed from the surgery.

After Surgery - Two drains are placed in the pelvis to prevent the pooling of blood at the surgical site where the rectum was joined together. This pooling of blood is called hematoma. A suction pump will be attached to the drains for the first few days after surgery.

When the surgeries are done, the pelvic cavity is washed out, the layers of muscle and skin are sewn together and the skin is closed with stitches or staples.

When the surgery is completed, the anesthesiologist stops the anesthesia. Once the anesthesiologist has made sure that the patient is breathing well on his or her own the breathing tube is removed. The patient is then transferred to the recovery room where he or she is monitored by a recovery room nurse. After the patient is awake and medically stable, he or she will be taken to a standard post-operative hospital room.

You will stay in the hospital about one week. You usually go back to the surgeon's office for a check-up about ten days after surgery. The staples in your skin are usually removed at this visit.