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An Anatomical Description

Vijay P. Khatri, MD; Miguel A. Rodriguez-Bigas, MD; Nicholas J. Petrelli, MD

Arch Surg. 2003;138:553-559.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

Abdominoperineal resection (APR) has remained the gold standard for management of distal rectal adenocarcinoma since the original description by W. Ernest Miles in 1908.¹ The classic Miles procedure involved a 1-team approach: after the initial abdominal mobilization of the rectosigmoid colon, the patient was placed in the left lateral position for the perineal proctectomy. Lloyd-Davies² described the currently popular synchronous, combined approach in 1939 after Devine³ introduced adjustable stirrups to place the patient in the lithotomy position. Several modifications of the Lloyd-Davies APR procedure have been described through the years, but the basic principles espoused by Miles remain unchanged.⁴

If the perineal surgeon lacks experience in performing APR, major complications can occur; furthermore, curability, as well as local control of the rectal cancer, can be potentially compromised. For surgical residents, experience in performing the perineal dissection may be . . . [Full Text of this Article]

DESCRIPTION OF THE PERINEAL ANATOMY

Coronal Anatomy

Sagittal Anatomy

Inferior View Anatomy

OPERATIVE TECHNIQUE

Position

Incision

Posterior Dissection

Lateral Dissection

Anterior Dissection

Closure

COMMENT

From the Division of Surgical Oncology, University of California, Davis Cancer Center, Sacramento, Calif (Dr Khatri); the Department of Surgery, M. D. Anderson Cancer Center, Houston, Tex (Dr Rodriguez-Bigas); and the Helen F. Graham Cancer Center, Newark, Del (Dr Petrelli).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pelvic Neuroanatomy and Technique of Abdominoperineal Resection of the Rectum for Cancer
Losanoff and Sauter
Arch Surg 2004;139:225-225.
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