Abdominoperineal resection (APR) has remained the gold standard for management of distal rectal adenocarcinoma since the original description by W. Ernest Miles in 1908. 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-Davies described the currently popular synchronous, combined approach in 1939 after Devine 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.
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