The retroperitoneal interfascial planes: current overview and future perspectives

Abstract

Recently, the concept of interfascial planes has become the prevalent theory among radiologists for understanding the retroperitoneal anatomy, having replaced the classic tricompartmental theory. However, it is a little known fact that the concept remains incomplete and includes embryological errors, which have been revised on the basis of our microscopic study. We believe that the concept not only provides a much clearer understanding of the retroperitoneal anatomy, but it also allows further development for diagnosis and treatment of retroperitoneal injuries and diseases, should it become an accomplished theory. We explain the history and outline of the concept of interfascial planes, correct common misunderstandings about the concept, explain the unconsciously applied therapeutic procedures based on the concept, and present future perspectives of the concept using our published and unpublished data. This knowledge could be essential to acute care physicians and surgeons sometime soon.

Embryonic developmental process and clinical anatomy of the preperitoneal fascia and its clinical significance

“…There are also various controversies regarding the origin, structure, nomenclature, and starting and ending points of the PPF [ 6 – 8 , 13 , 39 , 45 ]. Japanese scholar N. Asakage believed that the structural origin of this fascia belongs to a part of the retroperitoneal fascia [ 9 ], and other scholars believed that within the preperitoneal space, the transversalis fascia, PPF, umbilical prevesical fascia, and anterior bladder fascia are the same structure [ 36 , 49 ].…”

“…The anatomical studies related to the PPF have not been uniformly understood [ 4 – 8 , 13 , 36 , 39 , 45 , 49 , 56 , 58 ], with some scholars suggesting that the PPF is derived from the transversalis fascia and others suggesting that the PPF is an independent fascial structure. Most of the relevant studies have been confined to the anterior peritoneal space, which limits the understanding of the structure of the anterior peritoneal fascia.…”

Solid Primary Retroperitoneal Masses in Adults: An Imaging Approach

“…This advocates that the fasciae described above are not just “walls” that divide the retroperitoneal space but are layered planes with potential spaces within them, which can act as channels for the spread of disease beyond the compartment of origin. 4 The retromesentric plane develops from the multiple layers that make up Gerota's fascia. Similarly, the lateroconal plane corresponds to the lateroconal fascia and the retrorenal plane to the Zuckerkandl's fascia.…”

“…These three fascial planes unite at a point known as the fascial trifurcation where the anterior and posterior fascial planes meet and continue downward as the combined interfascial plane as mentioned above. 4 On CT and MRI, retroperitoneal fascial planes are usually detected when there is an abundance of retroperitoneal fat. Fascia measuring greater than 3 mm is considered thickened and fascial thickening is a sensitive, although nonspecific sign of a retroperitoneal pathologic process.…”

Multidetector Computed Tomographic Characterization of a Rare Retroperitoneal Mass in the Left Psoas Compartment

“…Meyers et al established the tricompartmental theory of the retroperitoneum. 1 The retroperitoneum is now understood to be a space bounded anteriorly by the parietal peritoneum (PP) and posteriorly by the transversalis fascia (TF) that underlies the transverse abdominis muscle. It is divided into five compartments (►Fig.…”