Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Abdominoperineal Resection of Rectum


Related Terms

  • Abdomino-endorectal Resection
  • APR
  • Bowel Resection
  • Colectomy
  • Excision of Distal Sigmoid
  • Excision of Rectosigmoid
  • Excision of Rectum
  • Mile's Procedure
  • Segmental Resection

Specialists

  • Anesthesiologist
  • Colon and Rectal Surgeon
  • General Surgeon

Comorbid Conditions

Factors Influencing Duration

The presence of underlying chronic conditions (e.g., diabetes, heart disease, chronic obstructive pulmonary disease [COPD], obesity, and mental health problems) might lengthen the period of disability by slowing healing of the surgical wounds. The presence or persistence of complications related to surgery also may increase duration.

Medical Codes

ICD-9-CM:
48.50 - Abdominoperineal Resection of Rectum, Not Otherwise Specified
48.51 - Laparoscopic Abdominoperineal Resection of the Rectum
48.52 - Open Abdominoperineal Resection of the Rectum
48.59 - Other Abdominoperineal Resction of the Rectum

Overview

Abdominoperineal resection of the rectum (APR) is an extensive operation that involves removal of the far end (distal) section of the large intestine, including the sigmoid colon, rectum, and anus. The large intestine consists of four sections: the ascending colon, transverse colon, descending colon, and the sigmoid colon, before ending at the rectum. The large intestine normally receives partially digested food from the small intestine, and extracts water and nutrients from the food before storing the rest as waste material (stool or feces) until it is eliminated from the body via the anus.

An APR is indicated for removing colorectal tumors or treating inflammatory conditions of the rectum that are near or extend into the anus. The term abdominoperineal is used because two incisions are needed to complete the surgery, an anterior incision in the abdomen and one in the perineal area below the pelvic diaphragm from the coccyx to the pubis. Generally, in an abdominoperineal resection (APR), an opening (stoma) is made through the wall of the abdomen through which waste products can be removed from the remaining intestinal tract instead of via the anus (colostomy). Sometimes the muscles that allow voluntary control and passage of stool can be preserved (sphincter saving or preserving) and a permanent colostomy is not necessary.

Source: Medical Disability Advisor



Reason for Procedure

An abdominoperineal resection generally is performed to remove (excise) a cancerous (malignant) tumor from the lower end of the rectum or the anus. Sometimes the tumor is too advanced for potential cure, but the procedure may be undertaken to remove as much tumor as possible in order to prolong life and prevent the tumor from obstructing the intestinal tract.

An abdominoperineal resection is sometimes performed to remove parts of the large intestine infected by inflammatory diseases of the lower colon, rectum, and anus such as ulcerative colitis and Crohn's disease (inflammatory bowel disease).

Source: Medical Disability Advisor



How Procedure is Performed

The operation is performed through two incisions, one in the abdomen and one through the region between the anus and the genitals (perineum). Surgery may proceed from the anterior abdominal incision to the perineal incision or the operation may be performed through both incisions simultaneously with two sets of surgical teams and equipment.

The individual is anesthetized, and the abdomen and perineum are cleansed with an antibiotic surgical scrub solution. A drainage tube (Foley catheter) is placed into the bladder to drain urine and a nasogastric tube is placed through the nose and into the stomach to drain gastric secretions. A long midline incision is made through the abdomen to the pubis, and the entire abdominal cavity is examined to identify spread of the tumor (tumor staging). Tumor mobility is assessed to determine if the tumor has become attached to pelvic organs. The surgeon gently works through (dissects) membranes and tissues that line the abdominal and perineal organs (peritoneum). Abdominal and peritoneal arteries and nerves are identified and protected and, if necessary, displaced and fastened to allow visualization of the operative area. Some vessels may need to be tied off (ligated) and blood flow stopped during surgery.

The perineal incision is made from the perineal body to the coccyx. The rectum is freed from surrounding tissue and removed. The bowel is also freed from surrounding tissue and cut loose. The end of the bowel that is to remain is examined to be certain that all tumors have been removed, and the open end of the descending colon is pulled through a stoma made in the abdominal wall using part of the existing incision site; the exposed end of the colon is then sutured to the skin surface so that waste can be redirected outside of the body (end-colostomy). The anus is removed and the area is irrigated, and any bleeding is stopped with electrocautery; vessels are sutured closed to achieve hemostasis. If the surgeon has any concern about blood flow (hemostasis) within the pelvis, the pelvic cavity may be packed. Otherwise, drains are placed into the pelvis and the incisions are sutured closed. Dressings are applied to both incisions, and tubing and a drainage bag are placed in the colostomy.

Source: Medical Disability Advisor



Prognosis

The 5-year survival rate for individuals who undergo surgical resection for colorectal cancer varies depending on the stage of the cancer at the time of surgery. If the cancer is contained within the intestinal wall (stage I), the 5-year survival rate is 83% to 90%. This decreases to 70% if the cancer extends into the fat layers (stage II) (Hassan). In individuals whose cancer has spread (metastasized) to nearby lymph nodes (stage III), the estimated survival rate is 30%, and cancer with distant metastases to liver, lung, or bone (stage IV) carries a 10% 5-year survival rate (Hassan).

Some individuals with colorectal cancer develop a recurrence of the tumor after surgery, usually within the first 4 years. The outcome is much poorer following recurrence of malignancy in another part of the intestinal tract.

The prognosis is better when APR is performed to treat inflammatory bowel disease. Individuals undergoing this surgery may be relatively disease free after a recovery period, and the inflammatory condition may be managed with medication and dietary guidelines.

Source: Medical Disability Advisor



Complications

Complications include bleeding, infection, wound healing problems, problems with the colostomy, and cardiopulmonary complications. Bladder problems also may develop. Another potential complication is damage to nerves in the perineal region of male patients, resulting in sexual dysfunction such as "dry" orgasms and release of semen into the bladder (retrograde ejaculation), or impotence.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

As with all surgery that involve abdominal incisions, moderate to heavy lifting should be avoided until there is satisfactory healing of the operative sites. Until there is satisfactory adjustment of the diet and the individual learns to handle the colostomy, more frequent restroom breaks may be necessary. Development of complications may increase the recovery time. Increased recovery time may also be needed if chemotherapy or radiation therapy follows surgery as treatment for cancer. Individuals undergoing chemotherapy may be at increased risk of infection, and may need to avoid individuals with infective illnesses.

There are profound psychological factors involved with undergoing this operation. Individuals must cope with the knowledge that they have cancer, and there is a period of adjustment to having the colostomy. Support groups of individuals who have undergone these types of operations may be of benefit in aiding recovery and improving quality of life.

Source: Medical Disability Advisor



References

Cited

Hassan, Isaac. "Colon, Adenocarcinoma." eMedicine. Eds. Eugene C. Lin, et al. 3 May. 2009. Medscape. 20 Aug. 2009 <http://emedicine.medscape.com/article/367061-overview>.

General

Khatri, Vijay, et al. "Abdominoperineal Resection of Rectum." Operative Surgery Manual. 1st ed. Saunders Elsevier, 2003.

Khatri, Vijay, et al. "Low Anterior Resection." Operative Surgery Manual. 1st ed. Saunders Elsevier, 2003.

Source: Medical Disability Advisor






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