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Operative Technique
May 2003

Perineal Dissection of Synchronous Abdominoperineal Resection of the RectumAn Anatomical Description

Author Affiliations

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).



Arch Surg. 2003;138(5):553-559. doi:10.1001/archsurg.138.5.553

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

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