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

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

1. IMA Division

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

1. Abdominal Dissection
2. Vaginal Dissection

9. Specimen Extraction, Hemostasis, and Irrigation

10. Right Rectus Abdominis Muscle Flap Harvesting

1. Dissection of Rectus Abdominis from Anterior Rectus Sheath
2. Superior Transection of Rectus Abdominis
3. Dissection of Rectus Abdominis from Posterior Rectus Sheath
4. Re-approximating Anterior and Posterior Sheaths

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