Denonvilliers’ fascia revisited

Abstract

Although several studies have reported that the peritoneum does not contribute to the formation of a fascia between the urogenital organs and rectum, Denonvilliers' fascia (DF), a fascia between the mesorectum and prostate (or vagina) in adults, is believed to be a remnant of the peritoneum. Remnants of the peritoneum, however, were reportedly difficult to detect in other fusion fasciae of the abdominopelvic region in mid-term fetuses. To examine morphological changes of the pelvic cul-de-sac of the peritoneum, we examined 18 male and 6 female embryos and fetuses. A typical cul-de-sac was observed only at 7 weeks, whereas, at later stages, the peritoneal cavity did not extend inferiorly to the level of the prostatic colliculus or the corresponding structure in females. The cul-de-sac had completely disappeared in front of the rectum at 8 weeks and homogeneous and loose mesenchymal tissue was present in front of the rectum at the level of the colliculus at 12-16 weeks. We found no evidence that linearly arranged mesenchymal cells developed into a definite fascia. Therefore, the development of the DF in later stages of fetal development may result from the mechanical stress on the increased volumes of the mesorectum, seminal vesicle, prostate and vagina and/or enlarged rectum. Therefore, we considered the DF as a tension-induced structure rather than a fusion fascia. Fasciae around the viscera seemed to be classified into (1) a fusion fascia, (2) a migration fascia and (3) a tension-induced fascia although the second and third types are likely to be overlapped.

Denonvilliers’ fascia in men: a sheet plastination and confocal microscopy study of the prerectal space and the presence of an optimal anterior plane when mobilizing the rectum for cancer

“…a), some superficial fibres from the longitudinal rectal muscle contribute to the perineal body as shown by others and project longitudinally or transversely to become continuous with the adipose fibrous meshwork within the prerectal space. It is therefore entirely plausible that mechanical stresses caused by rectal mobilization contribute to different configurations seen in the prerectal space . For these reasons, we agree with Lindsey et al .…”

Effect of preservation of Denonvilliers’ fascia during laparoscopic resection for mid-low rectal cancer on protection of male urinary and sexual functions

“…[10] This structure is present between the prostate or vagina and the mesorectum, and it is considered as a tension-induced structure or a peritoneal fusion fascia. [6,11,12] Some experts consider that DF forms the surface of the anterior aspect of the mesorectum and the optimal TME for rectal cancer is by dissection in front of DF. [5,13] However, some studies reveal that DF does not belong to proper fascia of rectum.…”

“…[5,13] However, some studies reveal that DF does not belong to proper fascia of rectum. [6,7,14] There were bilateral neurovascular bundles and their communicating branches crossing within DF closely. [15] Resection of DF may lead to damage of neurovascular bundles and urogenital dysfunction.…”

“…In addition, recent studies reveal that DF is not part of the proper fascia of rectum and should not be resected. [6,7] In brief, whether preservation of DF during TME is effective for protection of urogenital function is still largely elusive. It was the aim of this study to assess the effect of preservation of DF during laparoscopic resection for mid-low rectal cancer on protection of male urinary and sexual functions.…”

Total mesorectal excision for rectal cancer with emphasis on pelvic autonomic nerve preservation: Expert technical tips for robotic surgery

“…Denonvilliers' fascia is present between the anterior surface of the mesorectum and the prostate or vagina [32]. This fascia is a whitecolored membrane and has variable thickness from that of a thin translucent layer to a heavily thick layer.…”