Low Anterior Resection (LAR)
What is Low Anterior Resection (LAR) ?
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Why do you need Low Anterior Resection (LAR) ?
LAR is indicated for:
- Rectal cancer: Tumors in the upper or middle rectum (5–15 cm from the anal verge), where sphincter preservation is feasible.
- Select sigmoid colon cancers: Tumors near the rectosigmoid junction.
- Inflammatory bowel disease (IBD): Severe ulcerative colitis requiring rectal resection, often with pouch creation.
- Rare conditions: Large rectal polyps, endoscopically unresectable, or rectal trauma.
The procedure aims to remove cancerous or diseased tissue, prevent local recurrence, and restore bowel continuity without a permanent stoma in most cases.
Why Do Costs Vary in Philippines?
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Low Anterior Resection (LAR) Procedure
The procedure is tailored to the tumor’s location, stage, and patient’s overall health:
- Before Surgery Evaluation:
- Diagnosis is confirmed via:
- Colonoscopy with biopsy: Confirms rectal cancer and assesses its location and extent.
- MRI pelvis: Evaluates tumor depth, sphincter involvement, and lymph node status.
- CT/PET scans: Assesses metastasis (e.g., liver, lungs) for staging.
- Blood tests: Measure CEA (cancer marker), liver/kidney function, and anemia.
- Neoadjuvant therapy (chemoradiation) may be given for 4–6 weeks in locally advanced cases (T3–T4 or node-positive) to shrink the tumor and improve resection margins.
- Bowel preparation (laxatives, enemas) clears the colon 1–2 days before surgery.
- Patients with malnutrition or comorbidities may receive pre-surgery nutritional support.
- An enterostomal therapist marks a potential stoma site, as a temporary ileostomy is often created.
- Diagnosis is confirmed via:
- Surgical Techniques:
- Open Low Anterior Resection:
- Performed under general anesthesia, lasting 3–5 hours.
- A midline abdominal incision provides access to the rectum and sigmoid colon.
- The surgeon mobilizes the sigmoid colon and rectum, preserving pelvic nerves to maintain bladder and sexual function.
- The diseased segment (rectum and part of the sigmoid colon) is resected, ensuring clear margins (at least 1–2 cm distal to the tumor).
- Mesorectal excision (total mesorectal excision, TME) removes surrounding fat and lymph nodes to reduce local recurrence.
- The remaining colon is anastomosed to the lower rectum or anus using sutures or a stapling device (coloanal or colorectal anastomosis).
- A temporary loop ileostomy is often created to divert stool, protecting the anastomosis during healing.
- Laparoscopic Low Anterior Resection:
- A minimally invasive approach using 4–5 small incisions, a laparoscope (camera), and specialized instruments.
- Suitable for early-stage cancers or stable patients, offering less pain, smaller scars, and faster recovery.
- Takes 3–5 hours, with conversion to open surgery possible if complications arise.
- Robotic-Assisted Low Anterior Resection:
- Uses robotic systems (e.g., da Vinci) for enhanced precision, particularly in the narrow pelvis, improving nerve preservation.
- More expensive but available in centers like Apollo or Medanta.
- Additional Considerations:
- A temporary ileostomy is created in 50–70% of cases to reduce anastomotic leak risk, typically reversed after 3–6 months.
- Drains may be placed to manage fluid or infection, and the abdominal cavity is irrigated if contamination is present.
- Open Low Anterior Resection:
- After Surgery:
- Patients are monitored in the ICU for 1–2 days for pain, bowel function, and complications.
- Hospital stay lasts 5–10 days for open LAR or 3–7 days for laparoscopic/robotic LAR.
- Pathology reports confirm tumor margins, lymph node status, and staging, guiding adjuvant therapy (e.g., chemotherapy, radiation).
- Patients with ileostomies receive training from an enterostomal therapist for stoma care, including pouch changes and skin protection.
Recovery After Low Anterior Resection (LAR)
Recovery involves physical healing, restoring bowel function, and adapting to potential stoma:
- Hospital Stay:
- Open LAR requires 5–10 days, including 1–2 days in the ICU.
- Laparoscopic or robotic LAR involves 3–7 days, with 1 day in the ICU.
- Post-Surgery Care:
- Pain is managed with medications (e.g., epidural, opioids initially, then NSAIDs).
- IV fluids and gradual oral intake (clear liquids to soft foods) support bowel recovery, typically within 3–5 days.
- Antibiotics prevent infection; drains (if placed) are removed once output decreases.
- Ileostomy patients receive training on bag changes, skin care, and complication recognition (e.g., high output, dehydration).
- Activity and Diet:
- Light walking resumes within 1–2 days to prevent blood clots and promote bowel motility.
- Strenuous activities, heavy lifting, or driving are avoided for 6–8 weeks (open surgery) or 4–6 weeks (laparoscopic/robotic).
- A low-residue diet (e.g., white rice, bananas) is followed for 2–4 weeks, transitioning to high-fiber foods to regulate bowel movements.
- Hydration (2–3 liters daily) prevents dehydration, especially with ileostomies.
- Follow-Up:
- Follow-up visits at 1–2 weeks and 4–6 weeks assess wound healing, bowel function, and stoma status (if applicable).
- Cancer patients undergo CEA monitoring, CT scans, and colonoscopy every 3–6 months for 5 years to detect recurrence.
- Temporary ileostomies are typically reversed after 3–6 months, once the anastomosis heals (confirmed by contrast enema or sigmoidoscopy).
Most patients resume normal activities within 4–8 weeks, with laparoscopic patients recovering faster (4–6 weeks). For rectal cancer, 5-year survival rates are 70–90% for stage I–II and 50–70% for stage III with adjuvant therapy. Bowel function may take 6–12 months to stabilize, with some experiencing “low anterior resection syndrome” (LARS), including urgency, frequency, or incontinence.
Risks and Complications
LAR is a major surgery with potential risks:
- Surgical Risks:
- Bleeding, infection, or wound dehiscence at the incision site.
- Anastomotic leak (5–15%), causing peritonitis or abscesses, requiring reoperation or prolonged antibiotics.
- Stoma-Related Complications:
- Stoma prolapse, retraction, or blockage, needing revision surgery.
- Parastomal hernia or skin irritation around the stoma.
- General Risks:
- Adverse reactions to anesthesia.
- Blood clots (deep vein thrombosis or pulmonary embolism), requiring anticoagulants.
- Bowel obstruction from adhesions, potentially needing surgery.
- Cancer-Specific Risks:
- Local recurrence (5–15%), requiring further surgery or radiation.
- Distant metastasis, needing systemic therapy.
- Long-Term Issues:
- Low anterior resection syndrome (LARS, 30–50% of patients), causing bowel dysfunction (urgency, frequency, incontinence), often improving with pelvic floor therapy or medications.
- Sexual or urinary dysfunction due to nerve injury (5–20%), more common in open surgery.
Prompt reporting of symptoms like fever, severe pain, or no bowel output ensures timely management.
Frequently Asked Questions (FAQs)
What causes the need for LAR?
Primarily rectal cancer in the upper/middle rectum, but also sigmoid colon cancers, severe ulcerative colitis, or large rectal polyps.
Will I need a permanent stoma after LAR?
Most patients avoid a permanent stoma, as LAR preserves the sphincter. A temporary ileostomy is common (50–70%) to protect the anastomosis, reversed after 3–6 months.
Can LAR be done laparoscopically?
Yes, laparoscopic or robotic-assisted LAR is preferred for early-stage cancers or stable patients, offering faster recovery and less pain.
How soon can I resume normal activities?
Laparoscopic patients resume activities in 4–6 weeks; open surgery patients take 6–8 weeks.
Is LAR covered by insurance in India?
Most insurance plans cover LAR for cancer or IBD. Confirm with your provider.
What are the signs of complications post-LAR?
Fever, severe pain, no bowel movements, or stoma issues require immediate medical attention.
Will I have normal bowel function after LAR?
Bowel function may take 6–12 months to stabilize. Some patients experience LARS (urgency, frequency), manageable with diet, medications, or pelvic floor therapy.
What lifestyle changes are needed post-LAR?
Maintain a balanced diet, stay hydrated, avoid heavy lifting, manage stoma care (if applicable), and attend regular follow-ups, especially for cancer patients.
Conclusion
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Looking for Best Hospitals for Low Anterior Resection (LAR)
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
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Angeles City |
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Antipolo |
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Bacolod |
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Bacoor |
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Baguio |
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Butuan |
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Cagayan de Oro |
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Caloocan |
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Cebu City |
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Dasmariñas |
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Davao City |
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General Santos |
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General Trias |
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Iligan |
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Iloilo City |
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Las Piñas |
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Makati |
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Malolos |
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Manila |
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Muntinlupa |
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Parañaque |
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Pasay |
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Pasig |
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Puerto Princesa |
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Quezon City |
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San Fernando |
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San Jose del Monte |
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Taguig |
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Valenzuela |
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Zamboanga City |
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Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.