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Recent interpretations of Denonvilliers' fascia and the lateral ligament of the rectum
Author(s) -
Sakai Y,
Nomura A,
Masumori K,
Kawamura J,
Nagayama S
Publication year - 2009
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/j.1758-5910.2009.00004.x
Subject(s) - mesorectum , anatomy , fascia , neurovascular bundle , dissection (medical) , medicine , rectum , ligament , surgery , colorectal cancer , total mesorectal excision , cancer
The terms “Denonvilliers' fascia” and “lateral ligament of the rectum” will be very familiar to colorectal surgeons. However, how these structures are conceptualized remains controversial. Here, we review past and recent interpretations of these two terms. Denonvilliers' fascia is likely derived from the fusion of the two walls of an embryonic cul‐de‐sac to form a clear boundary between the neurovascular bundle and the mesorectum. When performing anterior dissection for mobilization of the rectum, it remains unclear whether the optimal dissection plane is in front of or behind Denonvilliers' fascia. Anatomical studies have shown that the lateral ligament may not be a clearly definable structure and that the middle rectal artery is not clinically significant. In the future, careful laparoscopic observations will give us a better understanding of these currently controversial anatomical features.