Ultra-Low Anterior Resection (ULAR)
What is Ultra-Low Anterior Resection (ULAR)?
Ultra-Low Anterior Resection (ULAR) is a surgical procedure to remove the rectum, including the lowest portion just above the anal sphincter (within 2–5 cm of the anal verge), typically for treating low rectal cancer while preserving sphincter function. The remaining colon is anastomosed to the anal canal (coloanal anastomosis), often with a temporary stoma to protect the anastomosis. In India, ULAR is performed in specialized colorectal surgery centers, offering high-quality care at affordable costs. For patients and families in India, understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for informed decision-making and optimal outcomes.
Why do you need Ultra-Low Anterior Resection?
ULAR is indicated for:
- Low rectal cancer: Tumors 2–5 cm from the anal verge, where sphincter preservation is feasible (T1–T3, N0–1, no sphincter invasion).
- Select benign conditions: Large rectal polyps or inflammatory bowel disease (IBD) with rectal involvement, though less common.
- Palliative cases: In patients unfit for abdominoperineal resection (APR) to avoid a permanent stoma.
The procedure aims to remove cancerous tissue with clear margins, preserve continence, and restore bowel continuity. In India, hospitals like Apollo, Fortis, Tata Memorial, Medanta, and AIIMS specialize in ULAR, using advanced techniques like laparoscopic or robotic-assisted surgery.
Why Do ULAR Costs Vary in India?
Costs range from ₹3 lakh to ₹10 lakh:
- Procedure Type: Open ULAR (₹3–6 lakh), laparoscopic (₹4–8 lakh), robotic (₹5–10 lakh).
- Hospital/Location: Higher in metro cities (Apollo, Tata Memorial); lower in government hospitals (AIIMS, ₹1–3 lakh).
- Surgeon’s Expertise: Experienced colorectal surgeons charge more.
- Additional Costs: Diagnostics (MRI, CT), ICU, neoadjuvant/adjuvant therapy (₹1–3 lakh), stoma supplies (₹2,000–₹5,000/month).
- Insurance: Covered for cancer; Ayushman Bharat offers subsidies.
Ultra-Low Anterior Resection Procedure
The procedure is tailored to the tumor’s location, stage, and patient health:
- Before Surgery Evaluation:
- Diagnosis:
- Colonoscopy with biopsy confirms rectal cancer.
- MRI pelvis assesses tumor depth, sphincter involvement, and lymph nodes.
- CT/PET scans evaluate metastasis for staging.
- Blood tests measure CEA (cancer marker) and surgical fitness.
- Neoadjuvant chemoradiation (4–6 weeks) is often given for T3–T4 or node-positive tumors to shrink the tumor and improve sphincter preservation.
- Bowel preparation (laxatives, enemas) clears the colon 1–2 days prior.
- An enterostomal therapist marks a stoma site for a temporary ileostomy.
- Diagnosis:
- Surgical Techniques:
- Open Ultra-Low Anterior Resection:
- Performed under general anesthesia, lasting 3–5 hours.
- A midline abdominal incision provides access to the rectum and sigmoid colon.
- The rectum is mobilized down to the pelvic floor, preserving pelvic nerves to maintain bladder/sexual function.
- Total mesorectal excision (TME) removes surrounding fat and lymph nodes to reduce recurrence.
- The rectum is resected just above the anal sphincter (distal margin 1–2 cm).
- The descending colon is anastomosed to the anal canal (coloanal anastomosis) using a stapling device or hand-sewn technique.
- A temporary loop ileostomy is created in 70–90% of cases to protect the anastomosis, reversed after 3–6 months.
- Laparoscopic Ultra-Low Anterior Resection:
- Minimally invasive, using 4–5 small incisions, a laparoscope, and instruments.
- Suitable for early-stage cancers, offering less pain and faster recovery.
- Takes 3–5 hours; conversion to open surgery is possible if complications arise.
- Robotic-Assisted Ultra-Low Anterior Resection:
- Uses robotic systems (e.g., da Vinci) for enhanced precision in the narrow pelvis, improving nerve preservation.
- More expensive, available in centers like Apollo or Medanta.
- Additional Considerations:
- A colonic J-pouch may be created during anastomosis to improve continence and reduce stool frequency.
- Open Ultra-Low Anterior Resection:
- After Surgery:
- ICU monitoring for 1–2 days manages pain, fluids, and stoma function.
- Hospital stay: 5–10 days (open), 3–7 days (laparoscopic/robotic).
- Pathology reports confirm margins, lymph node status, and staging, guiding adjuvant therapy (e.g., chemotherapy).
- Stoma care training is provided for temporary ileostomy patients.
Recovery After Ultra-Low Anterior Resection
- Hospital Stay: 5–10 days (open), 3–7 days (laparoscopic/robotic).
- Post-Surgery Care:
- Pain managed with medications (epidural, opioids, then NSAIDs).
- IV fluids and gradual oral intake resume within 3–5 days.
- Stoma care training for temporary ileostomy.
- Activity/Diet:
- Light walking in 1–2 days; strenuous activities avoided for 6–8 weeks (open) or 4–6 weeks (laparoscopic).
- Low-residue diet initially, progressing to high-fiber; 2–3 liters water daily.
- Follow-Up:
- Visits at 1–2 weeks, 4–6 weeks; cancer patients need CEA/CT every 3–6 months for 5 years.
- Ileostomy reversal after 3–6 months if anastomosis heals (confirmed by contrast enema).
Most resume normal activities in 4–8 weeks. Bowel function may take 6–12 months to stabilize, often with low anterior resection syndrome (LARS): urgency, frequency, or incontinence (30–50% of patients). Cancer survival: 70–90% (stage I–II), 50–70% (stage III).
Risks and Complications
- Surgical Risks: Bleeding, infection, anastomotic leak (10–20%, higher than standard LAR due to low anastomosis), requiring reoperation.
- Stoma Issues: Prolapse, retraction, or hernia.
- General Risks: Anesthesia reactions, blood clots, adhesions causing obstruction.
- Long-Term: LARS (urgency, frequency, incontinence), sexual/urinary dysfunction (nerve injury, 5–20%), cancer recurrence (5–15%).
Report fever, severe pain, or stoma issues promptly.
Frequently Asked Questions (FAQs)
What causes the need for ULAR?
Primarily low rectal cancer; rarely for benign conditions like large polyps or IBD.
Will I need a permanent stoma?
No, ULAR preserves the sphincter; a temporary ileostomy is common (70–90%), reversed after 3–6 months.
Can it be done laparoscopically?
Yes, for early-stage cancers, with faster recovery.
How soon can I resume activities?
4–6 weeks (laparoscopic), 6–8 weeks (open).
Is ULAR covered by insurance in India?
Yes, for cancer; confirm with your provider.
Signs of complications?
Fever, severe pain, no stoma output, or incontinence.
Will I have normal bowel function?
Bowel function may take 6–12 months; LARS (urgency, frequency) is common but manageable with pelvic floor therapy.
Lifestyle changes post-surgery?
High-fiber diet, hydration, pelvic floor exercises, regular cancer follow-ups.
Conclusion
ULAR is a sphincter-preserving procedure for low rectal cancer, balancing oncologic outcomes with quality of life. India’s top hospitals (Apollo, Tata Memorial, AIIMS) offer affordable, advanced care. Understanding the procedure, costs, recovery, risks, and FAQs helps patients approach ULAR confidently. Consult a colorectal surgeon for personalized guidance and successful treatment.
Looking for Best Hospitals for ULAR
Note: we are not promoting any hospitals
we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₹) | Maximum Price (₹) |
|---|---|---|
Agra |
3,00,000 |
9,00,000 |
Ahmedabad |
3,50,000 |
10,00,000 |
Ajmer |
3,00,000 |
9,00,000 |
Aligarh |
3,00,000 |
9,00,000 |
Allahabad |
3,00,000 |
9,00,000 |
Amritsar |
3,25,000 |
9,50,000 |
Aurangabad |
3,25,000 |
9,50,000 |
Bangalore |
3,50,000 |
10,00,000 |
Bareilly |
3,00,000 |
9,00,000 |
Belgaum |
3,25,000 |
9,50,000 |
Bhopal |
3,25,000 |
9,50,000 |
Bhubaneswar |
3,25,000 |
9,50,000 |
Bikaner |
3,00,000 |
9,00,000 |
Chandigarh |
3,50,000 |
10,00,000 |
Chennai |
3,50,000 |
10,00,000 |
Coimbatore |
3,50,000 |
10,00,000 |
Dehradun |
3,25,000 |
9,50,000 |
Delhi |
3,50,000 |
10,00,000 |
Dhanbad |
3,00,000 |
9,00,000 |
Durgapur |
3,00,000 |
9,00,000 |
Faridabad |
3,50,000 |
10,00,000 |
Ghaziabad |
3,50,000 |
10,00,000 |
Gorakhpur |
3,00,000 |
9,00,000 |
Guntur |
3,25,000 |
9,50,000 |
Gurgaon |
3,50,000 |
10,00,000 |
Guwahati |
3,25,000 |
9,50,000 |
Gwalior |
3,00,000 |
9,00,000 |
Hyderabad |
3,50,000 |
10,00,000 |
Indore |
3,25,000 |
9,50,000 |
Jabalpur |
3,00,000 |
9,00,000 |
Jaipur |
3,50,000 |
10,00,000 |
Jalandhar |
3,25,000 |
9,50,000 |
Jamshedpur |
3,25,000 |
9,50,000 |
Jodhpur |
3,00,000 |
9,00,000 |
Kanpur |
3,00,000 |
9,00,000 |
Kochi |
3,50,000 |
10,00,000 |
Kolkata |
3,50,000 |
10,00,000 |
Kollam |
3,25,000 |
9,50,000 |
Lucknow |
3,25,000 |
9,50,000 |
Ludhiana |
3,50,000 |
10,00,000 |
Madurai |
3,25,000 |
9,50,000 |
Mangalore |
3,25,000 |
9,50,000 |
Meerut |
3,00,000 |
9,00,000 |
Moradabad |
3,00,000 |
9,00,000 |
Mumbai |
3,50,000 |
10,00,000 |
Mysore |
3,50,000 |
10,00,000 |
Nagpur |
3,25,000 |
9,50,000 |
Nashik |
3,25,000 |
9,50,000 |
Navi Mumbai |
3,50,000 |
10,00,000 |
Noida |
3,50,000 |
10,00,000 |
Patna |
3,00,000 |
9,00,000 |
Pune |
3,50,000 |
10,00,000 |
Raipur |
3,25,000 |
9,50,000 |
Rajkot |
3,25,000 |
9,50,000 |
Ranchi |
3,00,000 |
9,00,000 |
Surat |
3,50,000 |
10,00,000 |
Thane |
3,50,000 |
10,00,000 |
Vadodara |
3,25,000 |
9,50,000 |
Varanasi |
3,00,000 |
9,00,000 |
Visakhapatnam |
3,25,000 |
9,50,000 |
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.