The lateral ligaments of the rectum: myth or reality?

The modern approach to rectal surgery aims at preserving the nerves to the urogenital system. The relationships between the lateral aspects of the rectum and the surrounding structures represent one of the most controversial points in the surgical anatomy of this area. This study was conducted on 27 fresh cadavers and 5 frozen pelvises. All dissections were performed with a technique similar to that used for the surgical mobilisation of the rectum. The lateral ligaments can be considered extensions of the mesorectum; they originate laterally to the middle portion of the rectum and descend posterolaterally to anchor to the endopelvic fascia. The lateral neurovascular pedicle of the rectum, comprising the middle rectal artery and the transverse autonomic nervous fibres, courses partially beneath the lateral ligament. The urogenital nervous bundle runs close to the point of insertion of the lateral ligaments in the endopelvic fascia, but is not covered with the same layer that forms the ligament itself. Anatomical dissection of cadavers is of invaluable help to the surgeon as it represents the basis for easy recognition of all the various structures in the rectal area.