Last updated: 02/17/2009

Both pelvic and orbital exenterations are considered to be major surgery and are performed under general anesthesia. The exact surgical procedure performed depends on the type of exenteration.

Pelvic exenteration

Pelvic exenterations...

start with an incision in the lower abdomen. Blood vessels are clamped and the organs specified by the procedure are removed. The site of incision is then stitched up. There are three types of pelvic exenteration: anterior, posterior, and total.

ANTERIOR EXENTERATION. This operation is called anterior exenteration because it removes organs toward the front of the pelvic cavity. It usually involves the removal of the female reproductive organs, bladder, and urethra. (In males, an operation that removes the bladder and prostate is called a cystoprostatectomy). Patients selected for this operation have cancers in areas that allow the rectum to be spared.

A new method for excreting urine must be created. One common approach, called an ileal conduit, diverts the ureters to a pouch made of small intestine, which is then connected to the abdominal wall. Urine exits the body through a small opening called a stoma, and collects in a small bag attached to the body. Vaginal reconstruction may also be performed during the exenteration, or in a later procedure.

POSTERIOR EXENTERATION. Posterior exenteration removes organs that are located in the back part of the pelvic cavity. These include the reproductive organs, plus the lower part of the bowel; the bladder and urethra are kept intact. A patient who has undergone posterior exenteration will require a colostomy, a procedure that connects the colon to the abdominal wall; waste exits the body through a stoma and is collected in a small bag.

TOTAL PELVIC EXENTERATION. This operation removes the bladder, urethra, rectum, anus, and supporting muscles and ligaments, together with the reproductive organs. Total pelvic exenteration is performed when there is no opportunity to perform a less extensive operation, because of the location and size of the cancer. A urinary stoma and a colostomy stoma will be created to collect waste.

Orbital exenteration

This operation removes the eyeball and surrounding tissues of the orbit. (Since the eye is surrounded by bone, orbital exenteration is often easier to tolerate than pelvic exenteration.) Orbital exenteration with partial preservation of eyelids and conjunctiva can sometimes be achieved. After the surgical site has healed, patients can be fitted with a temporary ocular prosthesis (plastic eye), although many patients prefer to wear an eye patch. Later, facial prostheses can be attached to the facial skeleton.