An abdominoperineal resection, formally known as abdominoperineal resection of the rectum and abdominoperineal excision of the rectum or simply abdominoperineal excision, or the Miles operation is a surgery for rectal cancer or anal cancer. It is frequently abbreviated as AP resection, APR and APER. positioning reduces perineal infections when performing the miles procedure The procedure has a reasonable morbidity rate and perineal wound infection. Request PDF on ResearchGate | Prone positioning reduces perineal infections when performing the miles procedure | Background Abdominoperineal resection.
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Improvements in perioperative care that came later reduced this considerably.
Refinements in technique continued through the first half of the 20th century. Gabriel described the operation in one stage, with miles procedure abdominal portion done supine and the perineal portion done in the left lateral position.
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- Technique of the radical abdomino-perineal (Miles's) operation
Lloyd—Davies' synchronous approach to the abdomen and miles procedure with the patient in the lithotomy position eliminated the cumbersome and sometimes dangerous need to reposition the patient while under anesthesia.
Minimally invasive techniques are also being applied to APR, with good initial results.
Parenteral antibiotics are given in the perioperative period. Cardiopulmonary risk is assessed and blood is typed and cross-matched.
Technique of the radical abdomino-perineal (Miles's) operation.
The surgeon or an enterostomal therapist will mark the future colostomy site, which should be positioned to avoid miles procedure midline incision, bony prominences, scars and natural skin folds. If the staging work-up determines that the mass is large, shows evidence of invasion into adjacent structures, or there is ureteral obstruction, stents should be placed before proceeding with an APR.
The patient can initially be positioned in modified lithotomy position using Allen stirrups or supine, if intraoperative repositioning miles procedure prone-jackknife or left lateral decubitus is chosen to perform the perineal portion of the operation.
We prefer the two-team approach with the patient in lithotomy position. Bilateral sequential compression devices are placed on the calves. The patient's legs are placed in the stirrups such that the weight is borne on the heels and there is no pressure on the peroneal nerve miles procedure it passes around the fibular head.
The hips must be abducted to accommodate the perineal dissector and are positioned at the end of the bed to allow ready access to the tip of the coccyx.
A Foley catheter is placed and draped over the thigh so as not to interfere miles procedure the perineal dissection.
Wellcome Library | Technique of the radical abdomino-perineal (Miles's) operation.
A pad is placed under the sacrum to protect it as well as to allow the perineum to project beyond the end of the table. This may be done using a closed system employing a three-way Miles procedure with a Pezzar catheter, or with a chest tube and syringes.
When all the effluent has drained, the anus is closed using a purse-string suture in the intersphincteric groove. The abdomen and perineum are then prepped and draped for surgery.
Rectal Cancer: Abdominoperineal Resection: How Is It Done and What Are the Results?
The miles procedure is entered through a midline incision extending from the pubis cephalad to just above the umbilicus. This should allow adequate visualization of the abdomen for the procedure. The incision can be extended cephalad if the splenic flexure requires mobilization. The liver is miles procedure thoroughly and intraoperative ultrasound may be employed if available.
Abdominoperineal resection - Wikipedia
The small bowel, peritoneal surfaces, and periaortic nodes are inspected. A wound protector and self-retaining retractor are placed to ease miles procedure. The small intestine is packed into the upper abdomen, and the resection is begun. The sigmoid is grasped and retracted to the patient's right.
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The lateral peritoneal edge is divided using electrocautery along the embryonic fusion miles procedure beginning at the level of the junction of the descending and sigmoid colon. As the dissection progresses distally, the left ureter should be identified as it crosses the left common iliac as injury to the ureter occurs most commonly at this phase.
The sigmoid and rectum are then retracted to the patient's left, and the parietal peritoneum at the base of miles procedure sigmoid mesentery is opened anterior to the aorta.