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Complications in Laparoscopic Colorectal Surgery
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Sanjiv Haribhakti, Shobhit Sengar
Presacral bleeding results from injury to the presacral venous plexus, or to the internal iliac vessels or their branches [21]. The bleeding can be massive since the presacral complex contains large-caliber veins and produces high-pressure bleeding when disrupted. Intraoperative presacral bleeding occurs in approximately 4% to 7% [22,23]. Tumors fixed to the sacrum, preoperative radiation, previous pelvic surgery, a distal location of the tumor, and surgical maneuvers that violate the presacral fascia increase the risk of presacral bleeding [24]. Bleeding from the fragile presacral vessels can be life-threatening [17]. Morbidity and mortality is high when surgery is required to manage presacral bleeding [25].
Colorectal cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Svetlana Balyasnikova, Gina Brown
A presacral recurrence pattern is recurrent disease on MRI arising on the anterior surface of the pelvic parietal, or presacral, fascia. This is characterized by intermediate signal following the plane of the presacral fascia. Disease can also recur behind this fascia and will characteristically bow the fascia forward and infiltrate towards the bony cortex of the sacrum.
Pelvis
Published in Harold Ellis, Adrian Kendal Dixon, Bari M. Logan, David J. Bowden, Human Sectional Anatomy, 2017
Harold Ellis, Adrian Kendal Dixon, Bari M. Logan, David J. Bowden
The rectum, from its narrow lumen at its origin, shown in the previous section, has widened into its patulous ampulla (16). Between the posterior aspect of the rectum (covered by its fascia propria) and the fascia covering the anterior aspect of the sacrum (13), the presacral fascia, is the connective tissue plane, which is developed in the surgical mobilization of the rectum and its vascular pedicle.
Very long-term outcome after resection rectopexy for internal rectal intussusception
Published in Scandinavian Journal of Gastroenterology, 2021
Annichen Durbeck, Hans-Olaf Johannessen, Anders Drolsum, Egil Johnson
Ligament preserving rectopexy [25] with suture and sigmoid resection was performed as described [16]. Briefly, rectum was mobilised posteriorly in the mesorectal plane to the tip of coccyx. Anteriorly the dissection was kept close to the rectal wall to the junction of the upper and middle third of vagina or to the seminal vesicles, preserving most of the lateral ligaments. The mesorectum was fixed loosely in the midline posteriorly with usually two absorbable sutures to the presacral fascia 2–4 cm below the promontory. It aimed at avoiding tension on the rectum, which followed the sacral curve. Redundant sigmoid was resected and the end-to-end anastomosis was stapled in the laparoscopically-assisted operations (n = 11) and hand sewn with continuous seromuscular suture in the open operations (n = 2), respectively.
Total mesorectal excision – 40 years of standard of rectal cancer surgery
Published in Acta Chirurgica Belgica, 2020
J. Votava, D. Kachlik, J. Hoch
The TME can be defined as a sharp dissection and a complete removal of the mesorectum, containing pararectal lymph nodes, along with its intact enveloping fascia [15]. Operative steps of the TME as described by Heald [16] are: 1. ligation of the inferior mesenteric artery at its origin; 2. mobilization of the left colic flexure; 3. transection of the left-sided colon at the junction between the descending and sigmoid colon; 4. sharp dissection in the avascular plane into the pelvis ventrally to the presacral fascia (of Waldeyer) and outside the enveloping visceral fascia of the rectum; 5. division of the lymphatic vessels and middle rectal vessels ventrolaterally at the level of the pelvic floor, 6. inclusion of all pelvic fat tissue and lymphatic structures to the level of the pelvic floor.
Topography of the pelvic autonomic nerves – an anatomical study to facilitate nerve-preserving total mesorectal excision
Published in Acta Chirurgica Belgica, 2022
Jan Gaessler, Friedrich Anderhuber, Sabine Kuchling, Ulrike Pilsl
Colorectal cancer is one of the most common malignancies worldwide. In both sexes combined, it ranks third in terms of incidence (10.2%), and second in terms of mortality (9.2%) [1]. After the proximal colon, the rectum represents the second most frequent tumour subsite (28%) in colorectal cancer [2]. The European Society for Medical Oncology defines rectal cancer as a lesion whose distal extension is located ≤15 cm from the anal margin (measured using rigid sigmoidoscopy) [3]. Total mesorectal excision (TME) represents the contemporary gold standard in radical surgical treatment of advanced rectal cancer [3]. TME can be defined as 'sharp, meticulous extirpation of the cancer en bloc with its surrounding perirectal lymphatic tissue contained within a thin fascial layer' [4]. The principle of TME is based on the understanding that 'removal of the whole visceral mesentery of the rectum' (i.e. the mesorectum) confines the entirety of tumour cells, thereby reducing local recurrence. The respective surgical plane has been established as the 'holy plane' of rectal cancer surgery. Posteriorly, it is located between mesorectum and presacral fascia, and extends laterally between mesorectum and parietal pelvic fascia (PPF) [5]. Anterior to the mesorectum, which contains small vessels, lymph nodes, and adipose tissue, lies the rectogenital septum (RGS). In women, it separates the rectum from the vagina (rectovaginal fascia). In men, it separates the rectum from the prostate (rectoprostatic or Denonvilliers' fascia, DVF). The adoption of TME has been pivotal in substantially reducing the local tumour recurrence rate [4]. The oncological superiority of TME can be ascribed to the practice of meticulously mobilising the mesorectum using sharp dissection which minimises the risk of breaching the enveloping mesorectal fascia (MRF), also called the visceral pelvic fascia. TME has also had a favourable impact on the preservation rate of urogenital function, because it facilitates the identification and sparing of the pelvic autonomic nerves [4]. Despite the ongoing progress in that particular field of surgery (i.e. transanal approach, robot-assisted surgery), urogenital dysfunction following rectal cancer surgery remains a common occurrence [6].