Proctectomy
What is Proctectomy?
A proctectomy is a surgical procedure involving the removal of the rectum, often performed to treat rectal cancer, severe inflammatory bowel disease (IBD), or other rectal conditions. Depending on the extent of resection and the underlying condition, it may include the anus (abdominoperineal resection, APR) or preserve sphincter function (as in restorative proctectomy with ileal pouch-anal anastomosis, IPAA). In India, proctectomy is conducted 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 Proctectomy?
Proctectomy is indicated for:
- Rectal cancer: Tumors in the lower rectum (0–5 cm from the anal verge) requiring complete rectal removal.
- Inflammatory bowel disease (IBD): Ulcerative colitis or Crohn’s disease with severe rectal involvement.
- Familial adenomatous polyposis (FAP): A genetic condition with multiple rectal polyps, necessitating rectal resection.
- Radiation proctitis: Severe rectal damage from prior radiation, unresponsive to medical therapy.
- Trauma or infection: Rare cases of rectal perforation, abscess, or fistulas.
The procedure aims to remove diseased tissue, prevent disease progression, and, when possible, restore bowel continuity. In India, hospitals like Apollo, Fortis, Tata Memorial, Medanta, and AIIMS specialize in proctectomy, using techniques like open, laparoscopic, or robotic-assisted surgery.
Why Do Proctectomy Costs Vary in India?
Costs range from ₹3 lakh to ₹10 lakh:
- Procedure Type: Open APR (₹3–6 lakh), IPAA (₹4–8 lakh), laparoscopic/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 or IBD; Ayushman Bharat offers subsidies.
Proctectomy Procedure
The procedure varies based on the condition, extent of resection, and sphincter preservation:
- 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.
- Diagnosis:
- 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.
- Abdominoperineal Resection (APR):
- 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.
Recovery After Proctectomy
- 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 colostomy (APR) or ileostomy (IPAA).
- 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 (IPAA) after 3–6 months if pouch heals.
Most resume normal activities in 4–8 weeks. Cancer survival: 60–80% (stage I–II), 40–60% (stage III). IPAA patients may experience frequent stools (4–8/day), improving over 6–12 months.
Risks and Complications
- Surgical Risks: Bleeding, infection, anastomotic leak (IPAA, 5–15%).
- Stoma Issues: Prolapse, retraction, hernia, or skin irritation.
- General Risks: Anesthesia reactions, blood clots, adhesions causing obstruction.
- Long-Term: Sexual/urinary dysfunction (nerve injury, 5–20%), pouchitis (IPAA, 20–40%), cancer recurrence (5–15%).
Report fever, severe pain, or stoma issues promptly.
Frequently Asked Questions (FAQs)
What causes the need for proctectomy?
Rectal cancer, ulcerative colitis, FAP, or severe rectal damage.
Will I need a permanent stoma?
Yes with APR (colostomy); IPAA avoids permanent stoma but includes a temporary ileostomy.
Can it be done laparoscopically?
Yes, for early-stage cancers or IBD, with faster recovery.
How soon can I resume activities?
4–6 weeks (laparoscopic), 6–8 weeks (open).
Is it covered by insurance in India?
Yes, for cancer or IBD; confirm with your provider.
Signs of complications?
Fever, severe pain, no stoma output, or urinary issues.
Will I have normal bowel function?
APR: No (colostomy). IPAA: 4–8 stools/day, improves over time.
Lifestyle changes post-surgery?
Stoma care, high-fiber diet, hydration, regular follow-ups for cancer/IBD.
Conclusion
Proctectomy effectively treats rectal cancer, IBD, and other conditions, with options for sphincter preservation or permanent stoma. India’s top hospitals (Apollo, Tata Memorial, AIIMS) offer affordable, high-quality care. Understanding the procedure, costs, recovery, risks, and FAQs helps patients approach proctectomy confidently. Consult a colorectal surgeon for personalized guidance and successful treatment.
Looking for Best Hospitals for Proctectomy
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 |
2,00,000 |
5,00,000 |
Ahmedabad |
2,50,000 |
5,50,000 |
Ajmer |
2,00,000 |
5,00,000 |
Aligarh |
2,00,000 |
5,00,000 |
Allahabad |
2,00,000 |
5,00,000 |
Amritsar |
2,25,000 |
5,25,000 |
Aurangabad |
2,25,000 |
5,25,000 |
Bangalore |
2,50,000 |
5,50,000 |
Bareilly |
2,00,000 |
5,00,000 |
Belgaum |
2,25,000 |
5,25,000 |
Bhopal |
2,25,000 |
5,25,000 |
Bhubaneswar |
2,25,000 |
5,25,000 |
Bikaner |
2,00,000 |
5,00,000 |
Chandigarh |
2,50,000 |
5,50,000 |
Chennai |
2,50,000 |
5,50,000 |
Coimbatore |
2,50,000 |
5,50,000 |
Dehradun |
2,25,000 |
5,25,000 |
Delhi |
2,50,000 |
5,50,000 |
Dhanbad |
2,00,000 |
5,00,000 |
Durgapur |
2,00,000 |
5,00,000 |
Faridabad |
2,50,000 |
5,50,000 |
Ghaziabad |
2,50,000 |
5,50,000 |
Gorakhpur |
2,00,000 |
5,00,000 |
Guntur |
2,25,000 |
5,25,000 |
Gurgaon |
2,50,000 |
5,50,000 |
Guwahati |
2,25,000 |
5,25,000 |
Gwalior |
2,00,000 |
5,00,000 |
Hyderabad |
2,50,000 |
5,50,000 |
Indore |
2,25,000 |
5,25,000 |
Jabalpur |
2,00,000 |
5,00,000 |
Jaipur |
2,50,000 |
5,50,000 |
Jalandhar |
2,25,000 |
5,25,000 |
Jamshedpur |
2,25,000 |
5,25,000 |
Jodhpur |
2,00,000 |
5,00,000 |
Kanpur |
2,00,000 |
5,00,000 |
Kochi |
2,50,000 |
5,50,000 |
Kolkata |
2,50,000 |
5,50,000 |
Kollam |
2,25,000 |
5,25,000 |
Lucknow |
2,25,000 |
5,25,000 |
Ludhiana |
2,50,000 |
5,50,000 |
Madurai |
2,25,000 |
5,25,000 |
Mangalore |
2,25,000 |
5,25,000 |
Meerut |
2,00,000 |
5,00,000 |
Moradabad |
2,00,000 |
5,00,000 |
Mumbai |
2,50,000 |
5,50,000 |
Mysore |
2,50,000 |
5,50,000 |
Nagpur |
2,25,000 |
5,25,000 |
Nashik |
2,25,000 |
5,25,000 |
Navi Mumbai |
2,50,000 |
5,50,000 |
Noida |
2,50,000 |
5,50,000 |
Patna |
2,00,000 |
5,00,000 |
Pune |
2,50,000 |
5,50,000 |
Raipur |
2,25,000 |
5,25,000 |
Rajkot |
2,25,000 |
5,25,000 |
Ranchi |
2,00,000 |
5,00,000 |
Surat |
2,50,000 |
5,50,000 |
Thane |
2,50,000 |
5,50,000 |
Vadodara |
2,25,000 |
5,25,000 |
Varanasi |
2,00,000 |
5,00,000 |
Visakhapatnam |
2,25,000 |
5,25,000 |
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.