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Surgical Endoscopy

, Volume 33, Issue 11, pp 3842–3850 | Cite as

The fusion fascia of Fredet: an important embryological landmark for complete mesocolic excision and D3-lymphadenectomy in right colon cancer

  • Alvaro Garcia-Granero
  • Gianluca PellinoEmail author
  • Matteo Frasson
  • Delfina Fletcher-Sanfeliu
  • Fernando Bonilla
  • Luis Sánchez-Guillén
  • Alberto Domenech Dolz
  • Vicent Primo Romaguera
  • Luis Sabater Ortí
  • Francisco Martinez-Soriano
  • Eduardo Garcia-Granero
  • Alfonso A. Valverde-Navarro
Dynamic Manuscript

Abstract

Background

The fusion fascia of Toldt is a well-known landmark used by colorectal surgeons. On the contrary, the fusion fascia of Fredet (the plane between the ascending mesocolon and the visceral duodenal-pancreatic peritoneum) still remains a neglected embryological structure. Aim of this study was to provide an anatomic description of this fascia and its application to minimally invasive D3-lymphadenectomy (D3-L) and complete mesocolic excision (CME) for right colon cancer.

Methods

First phase: Cadaveric dissection and anatomic description of the fascia of Fredet. Second phase: prospective evaluation of its surgical application in a consecutive series of laparoscopic right hemicolectomies with CME and D3-L at a tertiary hospital.

Results

The fascia of Fredet was identified and dissected in one fresh and two formalin-fixed cadavers. The trunk of Henle and the medial border of the superior mesenteric vein defined the medial limit of this embryologic plane. Seventeen patients were operated on. Laparoscopic dissection of the fascia of Fredet was possible in every patient. Median operative time was 210 (120–380) min. There were no major postoperative complications. All cases were adenocarcinomas, except one adenomatous polyp. T stage was Tis in three, T2 in two, T3 in seven, and T4 in five patients. Median number of harvested lymph nodes was 24 (9–39). Lymphatic invasion was found in six patients. All resections were classified as satisfactory mesocolic excision and R0. Median postoperative length of stay was 6 (4–20) days. Median follow-up time was 28 (16–41) months. Local and distal recurrence rate was 0.

Conclusion

The fusion fascia of Fredet is useful to achieve CME and D3-L in right colon cancers with reduced risk of intraoperative complications. This structure is particularly suitable for minimally invasive surgery; therefore, we encourage awareness of the fascia of Fredet by colorectal surgeons.

Keywords

Laparoscopy Colorectal surgery Fascia Surgical anatomy Fredet Training 

Notes

Compliance with ethical standards

Disclosures

Drs. Alvaro Garcia-Granero, Gianluca Pellino, Matteo Frasson, Delfina Fletcher Sanfeliu, Fernando Bonilla, Luis Sánchez-Guillén, Alberto Domenech Dolz, Vicent Primo Romaguera, Luis Sabater Ortí, Francisco Martinez-Soriano, Eduardo Garcia-Granero, and Alfonso A. Valverde-Navarro have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MP4 108,581 kb)

Supplementary material 2 (MP4 339,503 kb)

Supplementary material 3 (MP4 299,899 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Alvaro Garcia-Granero
    • 1
    • 2
  • Gianluca Pellino
    • 1
    • 3
    Email author
  • Matteo Frasson
    • 1
  • Delfina Fletcher-Sanfeliu
    • 4
  • Fernando Bonilla
    • 1
  • Luis Sánchez-Guillén
    • 1
  • Alberto Domenech Dolz
    • 1
  • Vicent Primo Romaguera
    • 1
  • Luis Sabater Ortí
    • 5
  • Francisco Martinez-Soriano
    • 2
  • Eduardo Garcia-Granero
    • 1
  • Alfonso A. Valverde-Navarro
    • 2
  1. 1.Colorectal Surgery UnitHospital Universitario y Politécnico “La Fe”ValenciaSpain
  2. 2.Department of Human Embryology and Anatomy DepartmentUniversity of ValenciaValenciaSpain
  3. 3.Department of Advanced Medical and Surgical SciencesUniversitá degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
  4. 4.Cardiovascular SurgeryHospital Universitario Son EspasesMallorcaSpain
  5. 5.Hepatobiliopancreatic Surgery UnitHospital Clínico UniversitarioValenciaSpain

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