Anatomic plane of separation between external anal sphincter and puborectalis muscle

Fucini, Claudio; Elbetti, C.; Messerini, Luca

doi:10.1007/bf02236356

Cited by 37 publications

(20 citation statements)

References 17 publications

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“…Within the U‐shaped levator hiatus formed by the puborectalis, lie the urethra, the vagina in females and the anal canal. Defects in any one, two or all three components of the anal sphincter complex may cause fecal incontinence secondary to anal sphincter dysfunction32, 33. The sonographic approach used in this paper can assist in diagnosing tears in all three components.…”

Section: Discussionmentioning

confidence: 99%

Transperineal three‐dimensional ultrasound in evaluating anal sphincter muscles

Lee

Pretorius

Weinstein

et al. 2007

Ultrasound in Obstet & Gyne

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Objectives Results The proximal end of the anal canal (towards the rectum) consisted of overlapping IAS and PRM, and the distal end (towards the anus) consisted of overlapping IAS and external anal sphincter (EAS).At the PRM level, the mean ± SD IAS thickness was 2.3 ± 0.5 mm at rest and 2.5 ± 0.4 mm during squeezing, and at the mid-EAS level it was 2.9 ± 0.5 mm at rest and 2.8 ± 0.5 mm during squeezing. The PRM thickness was 6.5 ± 1.0 mm at rest and 6.4 ± 1.2 mm during squeezing. The difference in muscle thickness of the sphincter layers with the woman at rest and during squeezing was not significant. The anteroposterior length of the levator hiatus was 51.7 ± 5.0 mm at rest and 47.4 ± 4.1 mm during squeezing (P < 0.01).

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Section: Discussionmentioning

confidence: 99%

Transperineal three‐dimensional ultrasound in evaluating anal sphincter muscles

Lee

Pretorius

Weinstein

et al. 2007

Ultrasound in Obstet & Gyne

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“…[1][2][3][4] This separation is marked by a cleft in adult anatomic specimens 1 and by a depression palpable at mid anal canal in the living subjects. 5 A plane of separation can be identified and developed, endoanally, at this level.…”

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confidence: 99%

“…5 A plane of separation can be identified and developed, endoanally, at this level. 4 These muscles also have distinct, as well as quite separate, innervations. Direct branches of sacral roots running in their inner surface supply the levator muscles, whereas the pudendal nerve, which runs laterally and externally to them, innervates the external sphincter 3,6 The possible existence of a functional as well as anatomic separation between the two muscles suggested that one try to remove the rectum (along anatomic boundaries using a combined abdominoendoanal approach) together with a large portion of the levator muscles while preserving the lower anal canal and the external sphincter with its innervation (a major functional structure in the voluntary continence mechanism).…”

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confidence: 99%

Excision of the Levator Muscles With External Sphincter Preservation in the Treatment of Selected Low T4 Rectal Cancers

Fucini¹,

Elbetti²,

Petrolo³

et al. 2002

Diseases of the Colon &Amp; Rectum

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PURPOSE:The existence of an anatomic and functional separation between the puborectalis muscle and external anal sphincter permits the performance of an abdominoendoanal excision, instead of an abdominoperineal excision, of the rectum and levator muscles, with preservation of a functioning external sphincter, in selected patients with very low rectal cancer and limited infiltration of the levator muscles. METHODS: Seven patients (4 females; age, 48-69; mean, 60.7 Ϯ 7.8 years) with low posterior or posterolateral localized rectal cancers with infiltration of the puborectalis muscle (T4) were submitted to preoperative chemoradiation and excision of the rectum with the levator muscles, while the external sphincter and its innervation were preserved. A coloanal anastomosis was performed at the dentate line. RESULTS: At a median follow-up of 58 (range, 42-102) months, 6 patients (86 percent) were alive and disease free. No local recurrence was observed. Anorectal function, at three years from surgery was no worse than that of six patients of the same age and gender who had undergone more conventional coloanal anastomoses with preservation of the levator muscles. CONCLUSION: Selected patients with very low rectal cancers infiltrating the levator muscles (T4) and responding to preoperative chemoradiation therapy can still be treated with an advanced sphinctersparing procedure, instead of an abdominoperineal excision. Oncologic and functional results seem to be satisfactory.

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“…In addition to a layer of muscles with mainly sphincteric functions, a second layer has developed into a well-marked diaphragm, which constitutes a muscular and tendinous sheet attached to the inner circumference of the pelvis [Fritsch 1995, Occelli 2001, Pit 2003]. In this pel- [Marani et al 1993, Fucini, 1999, Marani 2002.…”

Section: Review Of the Literaturementioning

confidence: 99%