The Rectogenital Septum: Morphology, Function, and Clinical Relevance

Aigner, Felix; Zbar, Andrew P.; Ludwikowski, Barbara; Kreczy, Alfons; Kovács, Péter; Fritsch, Helga

doi:10.1007/s10350-003-0031-8

Cited by 131 publications

(72 citation statements)

References 32 publications

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“…28 Aigner et al also suggested that fasciae in the pelvis are formed by condensation of loose mesenchyme. 29 We fully agree with both descriptions and believe this has played a major role in the various interpretations of fasciae and nerves surrounding the rectum.…”

Section: Discussionsupporting

confidence: 81%

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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Section: Discussionsupporting

confidence: 81%

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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“…Experimental studies have shown that nerve ¢bers and receptors responsible for detecting rectal distension lie in the pelvic fascia and submucosal wall of the distal rectum [Scharli and Kiesewetter, 1970;Lane and Parks, 1977] with nerve ¢bers spreading throughout the rectovaginal wall [Aigner et al, 2004].…”

Section: Discussionmentioning

confidence: 99%

Innervation of the rectovaginal wall in patients with rectocele compared to healthy controls

Altman

Zhang

Falconer

2006

Neurourology and Urodynamics

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“…The septum is clearly marked by the visceral pelvic fascia or Denonvilliers fascia that separates the extraperitoneal rectum anteriorly from the vagina (Figs. 3.24 and 3.25 ) or prostate and seminal vesicles [ 8 ]. Developing the plane anterior to the fascia propria or extramesorectal plane may lead to resection of Denonvilliers fascia and is associated with an increased risk of bladder and sexual dysfunction due to sacrifi ce of branches of the pelvic plexus of the hypogastric nerves.…”

Section: Posterior and Lateral Compartmentsmentioning

confidence: 98%

Surgical Anatomy

Francone¹,

Landmann²

2014

Minimally Invasive Approaches to Colon and Rectal Disease

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Key Points• A thorough understanding of the anatomy is imperative for proper exposure during minimally invasive operations. Every effort must be made to gain a clear understanding of the relationship and spacial arrangement of vital structures prior to proceeding with dissection.• Excellent exposure, meticulous technique, and proper assistance cannot be overstated and are essential components to providing appropriate care to the patient, improving outcomes, and minimizing complications.• Tension/counter-tension is an essential maneuver in developing and maintaining correct exposure of planes during any minimally invasive colon and rectal procedure.• Retroperitoneal structures are always at risk during laparoscopic colectomy and must be identifi ed and avoided throughout the dissection: right colectomy (duodenum), transverse colectomy (pancreas and mesenteric vessels), left colectomy (ureter/gonadal vessels, autonomic nerves), and pelvic dissection (ureter, hypogastric nerves). IntroductionLaparoscopic and robotic dissection of the abdominal colon and rectum have become increasingly utilized both for benign and malignant disease processes. Based on the underlying disease, and sequela of such processes, practicing and becoming facile with the various approaches will make exposure safer, quicker, and more reproducible. A fundamental understanding of the surgical anatomy allows the surgeon to have the ability to proceed in a safe manner, perform an appropriate oncological resection, and allow for additional diagnostic and therapeutic maneuvering while maximizing quality of life and simultaneously reducing morbidity. Anatomy of Colonic Mesenteric VasculatureIleocolic, Middle Colic, and Right Colic Arteries (Figs. 3.1 , 3.2 and 3.3 ) A clear understanding of colon mesenteric vascular anatomy is critical in performing laparoscopic colon resections. A thorough knowledge of vascular anatomy is especially important when performing resections for colon cancer where high ligation of mesenteric vessels is required.Based on numerous anatomic, pathological, surgical, and radiologic studies, considerable variation exists in colonic vasculature (Fig. 3.3a-d ). These variations need to be considered when approaching any dissection. One such example is that of the right colic artery (RCA) as a direct tributary of the superior mesenteric artery (SMA) -this occurs in only 11 % of cases. Depending on the study, the RCA is a derived from branches of the ileocolic (ICA) and middle colic arteries (MCA) in up to 80-100 % of patients. Other variations include single (95 %) and double (4 %) MCA's. When a double-MCA was found, the RCA was invariably absent. Rather than the typical SMA origin, the MCA itself can originate from either hepatic or distal splenic arteries.Pearl : When performing right colectomy, one can take advantage of the constancy of the ileocolic vessels . The ileocolic artery always courses toward the ileocecal junction (Fig. 3.1 and 3.2 ) . By identifying the terminal ileum and the cecal junction and gently retracting the ...

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The Rectogenital Septum: Morphology, Function, and Clinical Relevance

Cited by 131 publications

References 32 publications

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

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

Innervation of the rectovaginal wall in patients with rectocele compared to healthy controls

Surgical Anatomy

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