Surgery is performed to remove cancerous tumours in the rectum or sigmoid colon, along with nearby lymph nodes, to reduce the risk of disease progression.
Laparoscopic Anterior Resection
Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Laparoscopic anterior resection is a minimally invasive surgical procedure to remove a diseased portion of the rectum or sigmoid colon while preserving bowel continuity. The procedure involves several small incisions in the abdomen, through which a camera and specialised instruments are inserted to perform the operation. After removing the affected section, the remaining healthy parts of the bowel are reconnected to maintain normal digestive function.
Indications for Laparoscopic Anterior Resection
Medical conditions affecting the rectum or sigmoid colon may require laparoscopic anterior resection, including both benign and malignant conditions.
Colorectal Cancer
Large Polyps
In cases where polyps are too large or complex to be removed endoscopically, surgical removal is required.
Diverticular Disease
When recurrent episodes of diverticulitis or complications such as strictures occur, surgery may be necessary if medical management is insufficient.
Inflammatory Bowel Disease
Severe cases of ulcerative colitis or Crohn’s disease affecting the rectum may require surgical treatment if medication does not provide adequate control.
Benefits of Laparoscopic Anterior Resection
Compared to open surgery, laparoscopic anterior resection provides several advantages for suitable patients.
Smaller Incisions
The procedure is carried out through multiple small incisions rather than a single large abdominal incision, resulting in reduced post-operative discomfort and less disruption to surrounding tissue.
Faster Recovery
Patients generally experience a shorter hospital stay and return to daily activities sooner than those undergoing open surgery, often by several weeks.
Reduced Blood Loss
The use of magnified visualisation and controlled instrument movements usually results in minimal blood loss during the procedure.
Lower Infection Risk
The smaller incisions and reduced tissue handling may decrease the likelihood of wound infections and other post-operative complications.
Preparing for Surgery
- Medical Evaluation: Patients undergo blood tests, chest X-ray, and ECG to assess general health. A CT scan of the chest, abdomen, and pelvis is performed to determine the extent of the disease and assist in surgical planning. If not already completed, a colonoscopy with tissue sampling may be required. These assessments are typically conducted two to three weeks before the operation.
- Medication Adjustments: Patients taking blood-thinning medication may need to stop these five to seven days before surgery. Adjustments may be needed for diabetic medication, depending on fasting requirements.
- Bowel Preparation: A clear liquid diet is required the day before surgery. A bowel-cleansing solution is used to empty the colon and rectum. In some cases, oral antibiotics may be prescribed to reduce bacterial presence in the bowel.
- Fasting Guidelines: No solid food should be consumed for six hours before the procedure. Clear fluids may be taken up to two hours before surgery.
Step-by-Step Procedure
Anaesthesia Administration
General anaesthesia is given through an intravenous line, and a breathing tube is inserted. Additional intravenous or arterial lines may be placed for fluid management and monitoring.
Incision and Port Placement
Four to five small incisions are made in the abdomen. A camera port is positioned near the umbilicus, with working ports placed strategically to allow instrument movement.
Bowel Mobilisation and Division
The affected section of the bowel is carefully separated from surrounding structures while preserving nerve function and blood supply. The rectum is divided using stapling devices, ensuring complete removal of diseased tissue while maintaining adequate length for reconnection.
Specimen Removal
The excised section of the bowel is placed in a protective retrieval bag to prevent contamination and is removed through one of the port sites. A detailed pathological examination is conducted to assess the tissue and determine any further treatment requirements.
Bowel Reconstruction
The remaining bowel sections are reconnected using stapling devices or sutures. If necessary, a temporary ileostomy is created to allow healing.
Incision Closure
The small incisions are closed with sutures or surgical glue. In some cases, a drain may be placed to prevent fluid accumulation.
Post-Surgical Care and Recovery
Immediate Post-operative Care
Patients are monitored in a recovery area for the first 24 to 48 hours. Vital signs, wound sites, and fluid balance are closely observed. Pain management starts with intravenous medication before transitioning to oral pain relief. In some cases, a urinary catheter and surgical drains may be placed temporarily.
Recovery
The hospital stay typically lasts four to seven days. Patients gradually progress from liquids to solid food as bowel function returns. Physiotherapists assist with mobility to aid circulation and prevent complications. After discharge, full recovery takes around four to six weeks, during which heavy lifting should be avoided. Walking regularly supports healing, and follow-up appointments ensure progress is monitored.
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Potential Risks and Complications
Possible surgical complications include anastomotic leak, which may require further intervention. Bleeding can occur and, in some cases, may necessitate a transfusion or additional surgery. Injury to nearby structures, such as the ureters or nerves, is rare but can have lasting effects. General risks include wound infections, urinary tract infections, and deep vein thrombosis. Long-term changes in bowel habits, urinary or sexual function, or the formation of adhesions may also occur.
Frequently Asked Questions
When can I return to work?
Office-based work is usually possible after four to six weeks, while physically demanding jobs may require eight to twelve weeks. A phased return may help patients adjust gradually.
When will my bowel movements return to normal?
Bowel habits can take several months to stabilise. Some patients may experience temporary diarrhoea, constipation, or increased frequency. Keeping a food diary and adjusting fibre intake can help manage symptoms during this period.
Will I need a temporary stoma?
A temporary ileostomy may be created to protect the bowel connection during healing. If required, it is usually reversed after three to six months, once healing is confirmed.
Partnered Programmes & Insurance Plans
For Singaporeans, Singapore Permanent Residents and Foreigners. Please speak to our friendly clinic staff about using your insurance plans.
Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 20 years of experience in clinical practice.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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Our Clinic Locations
Ark Surgical Practice – Mouth Elizabeth Medical Centre
3 Mount Elizabeth, #17-01
Singapore 228510
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Ark Surgical Practice – Mount Elizabeth Novena Hospital
38 Irrawaddy Road, #09-34
Singapore 329563
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Saturday: 9am – 12:30pm
Sunday & Public Holidays: Closed