Skip to main content

Advertisement

SpringerLink
Log in

Contribution to the surgical anatomy of the ligaments of the rectum

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Many authors have discussed the presence and the importance of the lateral ligaments of the rectum. Our contribution aims at clarifying some aspects of surgical anatomy that help in the preservation of the urogenital functions and may influence the surgical practice. METHODS: From 1994 to 1998 we examined 27 fresh cadavers and five embalmed pelves. We performed all dissections with a technique similar to that used for the surgical mobilization of the rectum. RESULTS: The lateral ligaments of the rectum are trapezoid structures originating from mesorectum and are anchored to the endopelvic fascia; as lateral extensions of the mesorectum, they must be included in the surgical specimen. According to our results, three main structures can be recognized laterally to the rectum: 1) the lateral ligament, which does not contain important structures; 2) the inferior hypogastric plexus and the urogenital bundle; and 3) the lateral neurovascular pedicle of the rectum that comprises the nervi recti and the middle rectal artery, both running under the lateral ligament, although at different angles. CONCLUSION: At the point of insertion into the endopelvic fascia, the lateral ligaments run close to the urogenital bundle. Nevertheless, the dissection at its attachment is safe if the urogenital bundle is kept under visual control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sauer I, Bacon HE. Influence of lateral spread of cancer of the rectum on radicability of operations and prognosis. Am J Surg 1951;81:111–20.

    Google Scholar 

  2. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 1982;69:613–6.

    Google Scholar 

  3. Wolff BG. Lateral margins of resection in adenocarcinoma of the rectum. World J Surg 1992;16:467–9.

    Google Scholar 

  4. MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993;341:457–60.

    Google Scholar 

  5. Scott N, Jackson P, Al-Jaberi T, Dixon MF, Quirke P, Finan PJ. Total mesorectal excision and local recurrence: a study of tumor spread in the mesorectum distal to rectal cancer. Br J Surg 1995;82:1031–33.

    Google Scholar 

  6. Hojo K, Sawada T, Moriya Y. An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy. Dis Colon Rectum 1989;32:128–33.

    Google Scholar 

  7. Reynolds JV, Joyce WP, Dolan J, Sheanan K, Hyland JM. Pathological evidence in support of total mesorectal excision in the management of rectal cancer. Br J Surg 1996;83:112–5.

    Google Scholar 

  8. Enker WE, Laffer UTH, Block GE. Enhanced survival of patients with colon and rectal cancer is based upon wide anatomic resection. Ann Surg 1979;190:350–60.

    Google Scholar 

  9. Quirke P, Dixon MF, Durdey P, Williams NS. Local recurrence of rectal cancer due to inadequate surgical resection. Lancet 1986;2:996–9.

    Google Scholar 

  10. Enker WE. Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg 1992;127:1396–402.

    Google Scholar 

  11. Jones TE. Complications of one-stage abdominoperineal resection of rectum. JAMA 1942;120:104–7.

    Google Scholar 

  12. Eckhardt C. Untersuchungen uber die erektion des penis beim unde. Beitr Anat Physiol 1863;3:123. Cited by: Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 1982;128:492–7.

    Google Scholar 

  13. Ashley FL, Anson BJ. The pelvic autonomic nerves in the male. Surg Gynecol Obstet 1946;82:598–608.

    Google Scholar 

  14. Lee JF, Maurer VM, Block GE. Anatomic relations of pelvic autonomic nerves to pelvic operations. Arch Surg 1973;107:324–8.

    Google Scholar 

  15. Walsh PC, Schlegel PN. Radical pelvic surgery with preservation of sexual function. Ann Surg 1988;208:391–400.

    Google Scholar 

  16. Prete F. L'approccio neuroanatomico alla chirurgia oncologica del retto: esigenza o moda? Chirurgia (Bucur) 1996;9:543–5.

    Google Scholar 

  17. Heald RJ, Ryall RDH. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986;1:1479–82.

    Google Scholar 

  18. Heald RJ. Discussion. In: Walsh PC, Schlegel PN. Radical pelvic surgery with preservation of sexual function. Ann Surg 1988;208:391–400.

    Google Scholar 

  19. Heald RJ. Breaching the mesorectum. Lancet 1990;335:1067–8.

    Google Scholar 

  20. Sato K, Sato T. The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia. Surg Radiol Anat 1991;13:17–22.

    Google Scholar 

  21. Goligher JC. The blood supply to the sigmoid colon and rectum with reference to the technique of rectal resection with restoration of continuity. Br J Surg 1949;37:157–62.

    Google Scholar 

  22. Michels NA, Siddharth P, Kornblith PL, Parke WW. The variant blood supply to the small and large intestines: its import in regional resections. J Int Coll Surg 1963;39:127–70.

    Google Scholar 

  23. Patricio J, Bernades A, Nuno D, Falcao F, Silveira L. Surgical anatomy of the arterial blood supply of the human rectum. Surg Radiol Anat 1988;10:71–5.

    Google Scholar 

  24. Kimmel DL, McCrea LE. The development of the pelvic plexuses and the distribution of the pelvic splanchnic nerves in the human embryo and fetus. J Comp Neurol 1959;10:271–91.

    Google Scholar 

  25. Crapp AR, Cuthbertson MS. William Waldeyer and the rectosacral fascia. Surg Gynecol Obstet 1974;138:252–6.

    Google Scholar 

  26. Uhlenhuth E, Day EC, Smith RD, Middleton EB. The visceral endopelvic fascia and the hypogastric sheath. Surg Gynecol Obstet 1948;86:9–28.

    Google Scholar 

  27. Hojo K. Anastomotic recurrence after sphincter-saving resection for rectal cancer. Dis Colon Rectum 1986;29:11–14.

    Google Scholar 

  28. Pearl RK, Monsen H, Abcarian H. Surgical anatomy of the pelvic autonomic nerves: a practical approach. Ann Surg 1986;52:236–7.

    Google Scholar 

  29. Church JM, Raudkivi PJ, Hill GL. The surgical anatomy of the rectum—a review with particular relevance to the hazards of rectal mobilisation. Int J Colorectal Dis 1987;2:158–66.

    Google Scholar 

  30. Goligher JC. Surgery of anus, rectum and colon. London: Bailliere Tindall, 1980.

    Google Scholar 

  31. Gabriel WB. The principles and practice of rectal surgery. London: H. K. Lewis, 1963:1–33.

    Google Scholar 

  32. Boxall TA, Smart PJG, Griffiths JD. The blood supply of the distal segment of the rectum in anterior resection. Br J Surg 1962;50:399–404.

    Google Scholar 

  33. Wilson PM. Anchoring mechanisms of the anorectal region. S Afr Med J 1967;141:1138–43.

    Google Scholar 

  34. Ayoub SF. Arterial supply to the human rectum. Acta Anat (Basel) 1978;100:317–27.

    Google Scholar 

  35. Northover JMA. The dissection in anterior resection for rectal cancer. Int J Colorectal Dis 1989;4:134–8.

    Google Scholar 

  36. Moriya Y, Hojo K, Sawada T, Koyama Y. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum 1989;32:307–15.

    Google Scholar 

  37. Block GE, Michelassi F. Pelvic lymphadenectomy with resection of the rectum. In: Wanebo HJ, ed. Colorectal cancer. Boston: Mosby, 1993:263–73.

    Google Scholar 

  38. Moriya Y. Pelvic node dissection with autonomic nerve sparing for invasive lower rectal cancer: Japanese experience. In: Wanebo HJ, ed. Colorectal cancer. Boston: Mosby, 1993:274–89.

    Google Scholar 

  39. Lazorthes F, Materre JP, Istvan G. Anatomie des nerfs pelviens et anastomose iléo-anale. Ann Chir 1993;47:996–9.

    Google Scholar 

  40. Campbell SC, Church JM, Fazio VW, Klein EA, Pontes JE. Combined radical retropubic prostatectomy and proctosigmoidectomy foren bloc removal of locally invasive carcinoma of the rectum. Surg Gynecol Obstet 1993;176:605–8.

    Google Scholar 

  41. Harnsberger JR, Vernava III AM, Longo WE. Radical abdominopelvic lymphadenectomy: historic perspective and current role in the surgical management of rectal cancer. Dis Colon Rectum 1994;37:73–87.

    Google Scholar 

  42. Moreira LF, Hizuta A, Iwagaki H, Tanaka N, Orita K. Lateral lymph node dissection for rectal carcinoma below the peritoneal reflection. Br J Surg 1994;81:293–6.

    Google Scholar 

  43. Moriya Y, Sugihara K, Akasu T, Fujita S. Patterns of recurrence after nerve-sparing surgery for rectal adenocarcinoma with special reference to loco-regional recurrence. Dis Colon Rectum 1995;38:1162–8.

    Google Scholar 

  44. Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 1996;182:495–502.

    Google Scholar 

  45. Rutegård J, Sandzén B, Stenling R, Wiig J, Heald RJ. Lateral rectal ligaments contain important nerves. Br J Surg 1997;84:1544–5.

    Google Scholar 

  46. Curti G, Maurer CA, Buchler MW. Colorectal carcinoma: is lymphadenectomy useful? Dig Surg 1998;15:193–208.

    Google Scholar 

  47. Nano M, Levi AC, Borghi F,et al. Observations on surgical anatomy for rectal cancer. Hepatogastroenterology 1998;21:716–26.

    Google Scholar 

  48. Halsted WS cited by. Michels NA, Siddharth P, Kornblith PL, Parke WW. The variant blood supply to the small and large intestines: its import in regional resections. J Int Coll Surg 1963;39:127–70.

    Google Scholar 

  49. Chalmers da Costa J cited by. Michels NA, Siddharth P, Kornblith PL, Parke WW. The variant blood supply to the small and large intestines: its import in regional resections. J Int Coll Surg 1963;39:127–70.

    Google Scholar 

  50. Deaver JB cited by. Michels NA, Siddharth P, Kornblith PL, Parke WW. The variant blood supply to the small and large intestines: its import in regional resections. J Int Coll Surg 1963;39:127–70.

    Google Scholar 

  51. Mayo W cited by. Michels NA, Siddharth P, Kornblith PL, Parke WW. The variant blood supply to the small and large intestines: its import in regional resections. J Int Coll Surg 1963;39:127–70.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From the Department of Clinical Pathophysiology, Section of General and Geriatric Surgery, Molinette Hospital, University of Turin, Torino, Italy

    M. Nano M.D., H. M. Dal Corso M.D., G. Lanfranco M.D. & M. Ferronato M.D.

  2. the Institute of Cellular Biology and Morphology, University of Lausanne, Lausanne, Switzerland

    J. P. Hornung M.D.

Authors
  1. M. Nano M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. M. Dal Corso M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Lanfranco M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Ferronato M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. P. Hornung M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Nano, M., Dal Corso, H.M., Lanfranco, G. et al. Contribution to the surgical anatomy of the ligaments of the rectum. Dis Colon Rectum 43, 1592–1597 (2000). https://doi.org/10.1007/BF02236746

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02236746

Key words

Search

Navigation