William Ernest Miles (15 January - 24 September ) was an English surgeon known for the Miles' operation: an abdomino-perineal excision for rectal. 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. Looking for online definition of Miles' operation in the Medical Dictionary? Miles' operation explanation free. What is Miles' operation? Meaning of Miles'.
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The liver is palpated thoroughly and intraoperative ultrasound may be employed if available. The small bowel, peritoneal surfaces, and periaortic miles operation are inspected.
The Abdominoperineal Excision (Miles' Operation)
A wound protector and self-retaining retractor are placed to ease dissection. The small intestine miles operation packed into the miles operation abdomen, and the resection is begun. The sigmoid is grasped and retracted to the patient's right. The lateral peritoneal edge is divided using electrocautery along the embryonic fusion plane 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 miles operation common iliac as injury to the ureter occurs most commonly at this phase. The sigmoid and rectum are then retracted miles operation the patient's left, and the parietal peritoneum at the base of the sigmoid mesentery is opened miles operation to the aorta.
The peritoneal incision is continued distally to the cul-de-sac medial to the right ureter, which can be readily identified as it enters the pelvis over the right common iliac artery.
The peritoneum is further incised onto the sigmoid mesentery to the point where the colon will be divided. The blood supply is identified, skeletonized, and suture-ligated at the origin of the superior hemorrhoidal artery.
It is unnecessary to ligate the inferior mesenteric artery at its origin as this has not been shown to increase survival. The areolar layer between the fascia propria of the rectum and the presacral fascia can now be entered at the level of the sacral promontory.
Miles operation must be taken at this point to identify and preserve the hypogastric nerves. Dissection in the areolar miles operation is continued distally using either sharp dissection or electrocautery.
Miles' operation | definition of Miles' operation by Medical dictionary
Dissection is aided by using a lighted St. Mark's retractor to hold the mesorectum anteriorly. As the dissection continues distally, Waldeyer's fascia is divided with electrocautery or sharply to avoid injuring the miles operation venous plexus.
Blunt dissection, which was classically taught, should be avoided.
The posterior dissection is continued down to the level of the levators. The dissection is continued laterally, aided by counter traction from the assistant with the lighted St. The lateral miles operation are cauterized or suture-ligated.
The lateral ligaments should be divided as close to the specimen as miles operation without compromising radial margins to avoid injury to the nervi erigentes. With division miles operation the lateral stalks bilaterally, attention can be turned to the anterior dissection.
The lateral peritoneal incisions are connected anteriorly at the rectouterine pouch, in women, or the rectovesical recess in men. It is not necessary to expose the seminal vesicles in men, thus avoiding injury to the nervi erigentes.
Mark's retractor on the vagina or prostate, the rectovaginal septum is dissected in women, or the layer posterior to Denonvilliers' fascia in men is dissected down to the miles operation floor anteriorly.
In women, the presence of an anteriorly based tumor may require performance of a posterior vaginectomy. When the pelvic floor is reached circumferentially around the rectum, the abdominal portion of the dissection is miles operation.
Attention is then turned to creation of the colostomy prior to closing the abdomen and proceeding with the perineal dissection.
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- The Abdominoperineal Excision (Miles' Operation)
A disk of skin is excised sharply at miles operation previously marked site in the left lower quadrant. The subcutaneous fat is retracted, but not excised, to expose the anterior rectus miles operation. A verticular cruciate incision is made in the rectus sheath using electrocautery.