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CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(02): 193-197
DOI: 10.1055/s-0041-1724054
Review Article

Understanding the Anatomy of the Denonvilliers Fascia: Review Article

Compreendendo a anatomia da fáscia de Denonvilliers: Artigo de revisão
Mohammed Yousef Alessa 
1   King Faisal University Surgery, Hofuf, Eastern Province, Saudi Arabia
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Abstract

The postoperative outcome of rectal cancer has been improved after the introduction of the principles of total mesorectal excision (TME). Total mesorectal excision includes resection of the diseased rectum and mesorectum with non-violated mesorectal fascia (en bloc resection). Dissection along the mesorectal fascia through the principle of the “holy plane” minimizes injury of the autonomic nerves and increases the chance of preserving them. It is important to stick to the TME principle to avoid perforating the tumor; violating the mesorectal fascia, thus resulting in positive circumferential resection margin (CRM); or causing injury to the autonomic nerves, especially if the tumor is located anteriorly. Therefore, identifying the anterior plane of dissection during TME is important because it is related with the autonomic nerves (Denonvilliers fascia). Although there are many articles about the Denonvilliers fascia (DVF) or the anterior dissection plane, unfortunately, there is no consensus on its embryological origin, histology, and gross anatomy. In the present review article, I aim to delineate and describe the anatomy of the DVF in more details based on a review of the literature, in order to provide insight for colorectal surgeons to better understand this anatomical feature and to provide the best care to their patients.

Resumo

O resultado pós-operatório do câncer retal foi melhorado após a introdução dos princípios da excisão total do mesorreto (TME, na sigla em inglês). A excisão total do mesorreto inclui a ressecção do reto e do mesorreto afetados com fáscia mesorretal não violada (ressecção em bloco). A dissecção ao longo da fáscia mesorretal pelo princípio do “plano sagrado” minimiza a lesão dos nervos autônomos e aumenta a chance de preservá-los. É importante seguir o princípio da TME para evitar: a perfuração do tumor; a violação da fáscia mesorretal, resultando em margem de ressecção circunferencial (CRM) positiva; ou a lesão aos nervos autônomos, especialmente se o tumor estiver localizado anteriormente. Portanto, a identificação do plano anterior de dissecção durante a TME é importante, pois está relacionada com os nervos autonômicos (fáscia de Denonvilliers). Embora existam muitos artigos sobre a fáscia de Denonvilliers (DVF, na sigla em inglês) ou o plano de dissecção anterior, infelizmente não há consenso sobre sua origem embriológica, histologia e anatomia macroscópica. No presente artigo de revisão, pretendo delinear e descrever a anatomia da DVF em mais detalhes com base em uma revisão da literatura, a fim de fornecer subsídios para os cirurgiões colorretais entenderem melhor esta característica anatômica e fornecer o melhor cuidado para seus pacientes.

Keywords

anatomy of denonvilliers fascia - understanding anatomy - review article

Palavras-chave

anatomia da fáscia denonvilliers - compreensão da anatomia - artigo de revisão


Publication History

Received: 20 May 2020

Accepted: 23 August 2020

Article published online:
24 May 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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