Abdominoperineal excision is a surgical operation that involves cutting out (excising) tissue through both the abdomen and the perineum. The name tells you exactly how it works: the surgeon approaches the body from two directions at once — through the abdomen (the belly) above, and through the perineum (the area between the anus and genitals) below.
It is also commonly known as abdominoperineal resection (APR) or the Miles procedure. “Excision” and “resection” both mean the surgical removal of tissue.
What it’s used for
This operation is most often performed to treat cancer of the lower rectum or the anus — tumours that sit too low down to be removed and reconnected safely by other methods. Because of the tumour’s position, the surgeon needs to remove the lowest part of the bowel along with the anus itself.
How it works
The procedure combines two surgical approaches in a single operation:
- The abdominal part — the surgeon opens or accesses the abdomen (sometimes with keyhole/laparoscopic techniques) to free the affected section of bowel from above.
- The perineal part — working from below, the surgeon removes the anus and the lowest section of the rectum.
Because the anus and the normal exit for waste are removed, the bowel cannot be reconnected. Instead, the surgeon creates a permanent colostomy — the end of the remaining bowel is brought out through an opening (a stoma) on the abdominal wall, and waste is collected in a bag. Many people adjust well to living with a stoma over time.
What recovery involves
As a major operation, recovery takes time and usually includes a hospital stay, gradual return to normal activity, and learning to manage the colostomy with the help of specialist stoma care nurses. Follow-up care is important, both for healing and for monitoring the underlying condition that made the surgery necessary.
Why the combined approach matters
The “abdominoperineal” design exists because some tissue simply cannot be reached safely from one direction alone. By working from both the belly and the perineum, surgeons can completely remove low-lying tumours while giving the best chance of clear margins. It’s a strong example of how the procedure’s name describes its method precisely.
Disclaimer
This content is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Abdominoperineal excision is a major operation with lasting effects, and every case is different. Decisions about whether it is appropriate, and what to expect, must be made together with qualified healthcare professionals based on your individual situation. If this procedure has been recommended or discussed with you, speak with your surgical team or doctor for guidance specific to your circumstances.