Anatomic study of denonvilliers fascia and its application in rectal surgery

Objective To explore the anatomic characteristics of Denonvilliers fascia, and provide a theoretical basis for the selection of colorectal cancer resection in front plane. Methods Sixteen healthy adult pelvic anatomy specimens were observed from July 2012 to January 2014, including 4 cases of whole pelvis specimens (3 males and 1 female); 12 specimens were performed longitudinal incision(10 males, 12 females). The attachment points and adjacent structures of Denonvilliers fascia, and the relationship of Denonvilliers fascia and pelvic plexus were observed. Four cases of Denonvilliers fascia specimens were selected in 26 male patients, who underwent surgery in Shanxi Tumor Hospital from April 2013 to September 2013. The specimens were embedded in paraffin, sliced, and stained by HE to observe Denonvilliers fascia structure under light microscopy. Results Denonvilliers fascia went from the cephalicsince the peritoneal reflection, the vertical integration of the caudal traveled perineal body, through the pelvic wall fascia on both sides to continue to walk the line laterally, eventually splitting the pelvic muscles attached to the structure. Visible beneath the fascia attachment Denonvilliers fascia and pelvic wall covered by the pelvic wall fascia urogenital nerves passed through, and the confluence with the formation of vascular bundle urogenital neurovascular bundle. Some small nerves visible traffic branch connecting the left and right pelvic plexus went on Denonvilliers fascia. A column of the tissues like fence, which connected the inherent fascia of the rectum and the fascia of the pelvic wall, could be observed back to the Denonvilliers fascia 0.5-0.8 cm. And the relationship between Denonvilliers fascia and the other tissues was also more intimate to free at the bottom. Conclusions The relationship between Denonvilliers fascia and urogenital nerve is very close. Wrong plane resection of Denonvilliers fascia may damage the genitourinary nerves, which leads to postoperative urinary function, and sexual dysfunction. Therefore, the choice should be based on individual programs, and avoid being close to the outer edge of the fascia Denonvilliers resection. Key words: Rectal neoplasmscancer; Denonvilliers fascia; Total mesorectal excision