The procedure varies based on the condition, extent of resection, and sphincter preservation:

1. Before Surgery Evaluation:
   
   • Diagnosis:
     
     • Colonoscopy with biopsy confirms rectal cancer or IBD.
     • MRI pelvis assesses tumor depth, sphincter involvement, and lymph nodes.
     • CT/PET scans evaluate metastasis for cancer staging.
     • Blood tests measure CEA (cancer marker) and overall fitness.
   • Neoadjuvant therapy (chemoradiation) may be given for 4–6 weeks in rectal cancer (T3–T4 or node-positive) to shrink tumors.
   • Bowel preparation (laxatives, enemas) clears the colon 1–2 days prior.
   • An enterostomal therapist marks a stoma site for a colostomy or ileostomy.
2. Surgical Techniques:
   
   • Abdominoperineal Resection (APR):
     
     • For low rectal cancers involving the sphincter or anus.
     • Performed under general anesthesia, lasting 3–5 hours.
     • Two incisions: abdominal (midline) to mobilize the rectum and sigmoid colon, and perineal to remove the anus and sphincter.
     • Total mesorectal excision (TME) removes surrounding fat and lymph nodes.
     • The rectal stump is closed, and a permanent end colostomy is created on the abdominal wall to divert stool.
   • Proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA):
     
     • For ulcerative colitis or FAP, preserving continence.
     • The colon and rectum are removed, and a J-shaped pouch is created from the ileum, anastomosed to the anus.
     • A temporary loop ileostomy protects the pouch, reversed after 3–6 months.
     • Takes 4–6 hours, often staged (2–3 surgeries) for unstable patients.
   • Laparoscopic Proctectomy:
     
     • Minimally invasive, using 4–5 small incisions and a laparoscope.
     • Suitable for early-stage cancers or IBD, offering less pain and faster recovery.
   • Robotic-Assisted Proctectomy:
     
     • Uses robotic systems (e.g., da Vinci) for precision in the pelvis, minimizing nerve damage.
     • Available in advanced centers like Apollo or Medanta.
3. After Surgery:
   
   • ICU monitoring for 1–2 days manages pain, fluids, and stoma function.
   • Hospital stay: 5–10 days (open surgery), 3–7 days (laparoscopic/robotic).
   • Pathology reports guide adjuvant therapy (e.g., chemotherapy for cancer).
   • Stoma care training is provided for colostomy/ileostomy patients.