Modified Posterior Exenteration (Ovarian Cancer) with End-to-End Anastomosis


Assessment & Surveillance
 
  • Patient is placed in modified lithotomy position.
  • Full and comprehensive assessment of the abdomen
Enbloc hysterectomy with rectosigmoid resection
 
 
 
 
  • Identification of ureters
  • Division of the IP ligaments
  • Uterine artery division bilaterally
  • Opening the vagina anteriorly and dissect off the rectum.
Dissection of the rectum and stump preparation

 

 

 

  • Rectal fat is dissected carefully white preserving blood supply
Proximal bowel mobilisation

 

 

  • Mobilisation of sigmoid and descending colon.
  • IMA divided proximally to allow approximation without tension
Anastomosis preparation

 

 

  • Clear anastomosis edges from fat & epiploic appendages.
  • Use 2/0 proline suture for closure of the proximal end 
Anastomosis and safety checks

 

 

  • Ensure clear visualisation 
  • Apply orientation sutures to ensure proximal and distal ends are in the correct orientation 
Final note: Governance and interdisciplinary collaboration

Complex pelvic surgery with bowel resection and reanastomosis is routinely carried in the UK jointly and in collaboration with colorectal surgeons  colleagues. The anastomosis in this case was assisted my Mr Mark George ( Consultant General &Colorectal Surgeon)