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Gaessler,J.
Topography of the Ureter and Hypogastric Nerve in relation to the Mesorectal Fascia and Inferior Hypogastric Plexus
Humanmedizin; [Diplomarbeit] Medical University of Graz;2019. pp. 111 [OPEN ACCESS]
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Authors Med Uni Graz:
Advisor:: Pilsl Ulrike
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Abstract:: Colorectal cancer is one of the most common malignancies worldwide and affects the rectum in roughly one out of four cases. Total mesorectal excision (TME) represents the contemporary gold standard in the surgical treatment of carcinoma of the rectum. After its widespread adoption, TME was observed to produce excellent oncological results and make for a reduced demeanor of postoperative urogenital dysfunction. The purpose of this study was to examine the topography of the pelvic autonomic nerves in relation to the mesorectal fascia (MRF) in order to understand the theoretical superiority of TME in terms of autonomic nerve preservation. Furthermore, the course of the pelvic ureter was investigated so as to check for the possibility of iatrogenic injury during TME. As part of the experimental work, 48 Thiel-embalmed bodies-donated-to-science in total were dissected of which only 28 were included for statistical analysis. The MRF encompassed the mesorectum circumferentially and became continuous with the parietal pelvic fascia (PPF) via the lateral ligaments of the rectum and the rectosacral fascia. Otherwise, both layers were separated from each other through areolar tissue. Anteriorly, the MRF was tightly adherent to Denonvilliers' fascia. The pelvic autonomic nerves were either located amid or beneath the PPF. The inferior hypogastric plexus (IHP) resided at the level of the fourth and fifth sacral vertebrae, approximately 84.8 ±7.7 mm from the sacral promontory and 47.2 ±5.1 mm from the coccygeal apex. The pelvic ureter coursed in close proximity to both the IHP (10.7 ±2.0 mm) and the anterolateral aspect of the MRF (13.1 ±2.6 mm). Nonetheless, it didn't interfere with the dissection plane in TME. Conclusively, these results endorse the utilization of TME in rectal cancer surgery since the application of its principles allows for the preservation of the pelvic autonomic nerves. Moreover, TME minimizes the risk of iatrogenic ureteral injury.