Extralevator Abdominoperineal Resection (APR) for Recurrent Anal Cancer With an En Bloc Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy and Total Vaginectomy With Permanent Colostomy Formation and Pelvic Floor Reconstruction Using a Right Rectus Abdominis Flap
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Procedure Outline
Table of Contents
- 1. Introduction
- 2. Cystoscopy and Placement of Bilateral Ureteral Stents and Foley Catheter
- 3. Incision and Access to the Abdomen
- 4. Lateral Dissection of Left (Descending) Colon
- 5. Medial Left/Sigmoid Colon Mobilization
- 6. Pelvic Extralevator Total Mesorectal Dissection
- 7. Perineal Extralevator Dissection Posteriorly
- 8. Total Abdominal Hysterectomy and Bilateral Salpingo-oophorectomy with Total Vaginectomy for Resection of en Bloc Specimen
- 9. Specimen Extraction, Hemostasis, and Irrigation
- 10. Right Rectus Abdominis Muscle Flap Harvesting
- 11. Drain Placement in Left Lower Quadrant (LLQ)
- 12. Creation of Colostomy in LLQ, Pelvic Floor Reconstruction with Right Rectus Abdominis Flap, and Abdominal Wall Closure
- 13. Colostomy Maturation
- IMA Division
- Abdominal Dissection
- Vaginal Dissection
- Dissection of Rectus Abdominis from Anterior Rectus Sheath
- Superior Transection of Rectus Abdominis
- Dissection of Rectus Abdominis from Posterior Rectus Sheath
- Re-approximating Anterior and Posterior Sheaths