Preservation of Denonvilliers' fascia for nerve‐sparing laparoscopic total mesorectal excision: A neuro‐histological study

Abstract

Urogenital complications due to pelvic autonomic nerve damage frequently occur following rectal surgery. We investigated whether total mesorectal excision (TME) with preservation of the Denonvilliers' fascia (DVF) can effectively prevent the removal of pelvic autonomic nerves through microscopy. Twenty consecutive male patients with mid-low rectal cancer who received TME with preservation or resection of the Denonvilliers' fascia (P and R groups, respectively) were included. Serial transverse sections from surgical specimens were studied histologically. Nerve fibers at the surfaces of the mesorectum were counted. Clinical correlation between the amount of nerve fibers removed and post-operative sexual function was analyzed. Nerve fibers closely localized to the DVF in the R group displaying rich erectile activity (positive anti-nNOS immunostaining). At the anterior surface of the mesorectum, the mean numbers of nNOS-positive nerve fibers per specimen in the P group were significantly lower than the R group (3.0 AE 1.8 vs. 5.0 AE 2.3, P < 0.05). Compared to the R group, patients in the P group had higher IIEF scores and better erectile function at 3 and 6 months post-operatively. The DVF is a key risk zone for pelvic denervation during laparoscopic TME. Preservation of the DVF can prevent the removal of autonomic nerves and protect postoperative erectile function. Clin. Anat. 32:439-445, 2019.

Effect of Denonvilliers’ Fascia Preservation Versus Resection During Laparoscopic Total Mesorectal Excision on Postoperative Urogenital Function of Male Rectal Cancer Patients

“…28 Herein, the IIEF-5 score was significantly higher in the Exp-group than in the Con-group, which was consistent with our anatomical findings and results of neurofibrillary immunohistochemical staining of DVF. 17 Correspondingly, serious injury of the IMP, SHP, or HN leads to postoperative ejaculation dysfunction. This study revealed that the ejaculation function of the Exp-group was graded better than that of the Congroup, as nerve fibers in the DVF contain branches of the HN.…”

Identification of the surgical indication line for the Denonvilliers’ fascia and its anatomy in patients with rectal cancer

“…A series of our studies focuses on the male patients and male cadaver specimens. We have found that some pelvic autonomic nerves were closely related to Denonvilliers’ fascia and preservation of Denonvilliers’ fascia may have a better effect on the protection of urogenital function [18‐21].…”

Comparison of patient-reported quality of life and functional outcomes following laparoscopic and transanal total mesorectal excision of rectal cancer

“…In addition, the EORTC QoL scale for micturition problems at 1 year was worse in the LaTME group than in the TaTME group. During LaTME, pelvic dissection and traction of the bladder near the Denonvilliers' fascia may result in damage to the autonomic nerves [ 27 ]. Thus, TaTME may aid in the preservation of the autonomic nerves.…”