Perirectal Fascia and Spaces: Annular Distribution Pattern Around the Mesorectum

Zhang, Ce; Ding, Zihai; Li, Guoxin; Yu, Jiang; Wang, Yanan; Hu, Yanfeng

doi:10.1007/dcr.0b013e3181e74525

Cited by 52 publications

(27 citation statements)

References 15 publications

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

H¹,

Fang²,

Zheng³

et al. 2016

Medicine

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The aim of this study was to investigate the effect of preservation of Denonvilliers’ fascia (DF) during laparoscopic resection for mid-low rectal cancer on protection of male urogenital function. Whether preservation of DF during TME is effective for protection of urogenital function is largely elusive.Seventy-four cases of male mid-low rectal cancer were included. Radical laparoscopic proctectomy was performed, containing 38 cases of preservation of DF (P-group) and 36 cases of resection of DF (R-group) intraoperatively. Intraoperative electrical nerve stimulation (INS) on pelvic autonomic nerve was performed and intravesical pressure was measured manometrically. Urinary function was evaluated by residual urine volume (RUV), International Prostatic Symptom Score (IPSS), and quality of life (QoL). Sexual function was evaluated using the International Index of Erectile Function (IIEF) scale and ejaculation function classification.Compared with performing INS on the surfaces of prostate and seminal vesicles in the R-group, INS on DF in the P-group exhibited higher increasing intravesical pressure (7.3 ± 1.5 vs 5.9 ± 2.4 cmH2O, P = 0.008). In addtion, the P-group exhibited lower RUV (34.3 ± 27.2 vs 57.1 ± 50.7 mL, P = 0.020), lower IPSS and QoL scores (7 days: 6.1 ± 2.4 vs 9.5 ± 5.9, P = 0.002 and 2.2 ± 1.1 vs 2.9 ± 1.1, P = 0.005; 1 month: 5.1 ± 2.4 vs 6.6 ± 2.2, P = 0.006 and 1.6 ± 0.7 vs 2.1 ± 0.6, P = 0.003, respectively), higher IIEF score (3 months: 10.7 ± 2.1 vs 8.9 ± 2.0, P = 0.000; 6 months: 14.8 ± 2.2 vs 12.9 ± 2.2, P = 0.001) and lower incidence of ejaculation dysfunction (3 months: 28.9% vs 52.8%, P = 0.037; 6 months: 18.4% vs 44.4%, P = 0.016) postoperatively.Preservation of DF during laparoscopic resection for selective male mid-low rectal cancer is effective for protection of urogenital function.

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Section: Introductionmentioning

confidence: 99%

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

H¹,

Fang²,

Zheng³

et al. 2016

Medicine

View full text Add to dashboard Cite

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“…11 Many researchers have studied the perirectal fascia through macroscopic dissection. 10,[22][23][24][25][26][27] This causes problems as cadaveric or surgical dissections of an area rich in dense connective tissue may easily lead to the creation of artefacts. Radiologic imaging might be useful to study topographical relations, but fail to show enough detail due to limited resolution.…”

Section: Discussionmentioning

confidence: 99%

Understanding the surgical pitfalls in total mesorectal excision: Investigating the histology of the perirectal fascia and the pelvic autonomic nerves

Kraima

West

Treanor

et al. 2015

European Journal of Surgical Oncology (EJSO)

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AimExcellent understanding of the arrangement of fasciae and nerves surrounding the rectum is necessary for total mesorectal excision (TME). However, the fasciae anterolateral to the mesorectum and surrounding the low-rectum are still poorly understood. We studied the perirectal fascia along the complete length of the rectum in en-bloc cadaveric specimens and the University Medical Center Utrecht (UMCU) pelvic dataset, and describe implications for TME. MethodsFour donated human adult cadaveric specimens (two males, two females) were obtained through the Leeds GIFT Research Tissue Programme. Paraffin-embedded blocks were produced and serially sectioned at 50 and 250 m intervals. Whole mount sections were stained with haematoxylin & eosin,Masson's trichrome and Millers' elastin. Additionally, the UMCU pelvic dataset including digitalised cryosections of a female pelvis in three axes was studied. ResultsMultiple fascial layers surrounded the upper rectum. In the 'holy plane' of TME, laminae merged with the mesorectal and parietal fascia. Nerves ran directly laterally to the mesorectal fascia. More caudally, the mesorectal fascia approached the longitudinal layer of the rectal muscularis propria with the neurovascular bundles situated anterolaterally. The mesorectal fascia had a variable appearance in terms of thickness and completeness, which was most prominent anterolaterally. Conclusion 3Optimal TME requires dissection on the mesorectal fascia to preserve the nerves. Rectal surgeons are challenged in doing so as the mesorectal fascia varies in thickness and is often absent in some areas. More caudally, a wider excision may be needed to avoid incomplete specimens.4

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“…10 The possibility of left ureteral injury may increase when Toldt's space is broke through. After the pelvis is entered, the ureter, which is down between the front wall of the rectum and the posterior wall of the urinary bladder, is near to the lateral rectal ligament, and the ureter can be damaged when the lateral rectal ligament is separated.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Ureteral Injuries for Laparoscopic Rectal Cancer Surgery

Zhang

Wang

Zhou

et al. 2014

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Ureteral injury is one of the major complications for rectal surgery. However, few studies focused on ureteral injuries from laparoscopic rectal surgery have been reported. Characteristics of this kind of ureteral injuries and the related reasons are unclear. This study was designed to illustrate the characteristics of ureteral injuries during the procedure of laparoscopic rectal surgery and to analyze the related reasons. Of 1120 patients with rectal cancer who underwent laparoscopic surgery between July 2007 and July 2013, 11 cases had the complication of ureteral injuries. Data of these 11 patients were collected and analyzed retrospectively. In our study, the total incidence of ureteral injuries from laparoscopic rectal surgery was 0.98%, and left ureteral injuries were more common. Five cases of ureteral injuries occurred at the takeoff of the inferior mesenteric artery, 4 cases occurred at the small pelvic inlet, and 2 cases occurred at the location where the infundibulopelvic ligament crosses the pelvic brim. Four reasons accounted for the ureteral injuries: 5 cases resulted from massive ligation or cutting off without recognizing the anatomical structure, 3 cases resulted from unfamiliarity with normal anatomical structure under laparoscopy and unskilled laparoscopic operation, 2 cases resulted from an abnormal anatomical structure due to invasion of the tumor, and 1 case resulted from an unusual anatomical variation of ureter. It was easier to damage the left ureter during the procedure of laparoscopic rectal surgery. In conclusion, ureteral injuries usually occurred at three locations, and massive ligation or cutting off without recognizing the anatomical structure was the most common reason for laparoscopy-related ureteral injuries.

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Perirectal Fascia and Spaces: Annular Distribution Pattern Around the Mesorectum

Cited by 52 publications

References 15 publications

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

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

Understanding the surgical pitfalls in total mesorectal excision: Investigating the histology of the perirectal fascia and the pelvic autonomic nerves

Analysis of Ureteral Injuries for Laparoscopic Rectal Cancer Surgery

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