The parasympathetic supply to the distal colon—one marker for precisely locating the posterior dissection plane in the operation of TME

Abstract

It is important for surgeons to locate the reliable surgical planes in the operation of total mesorectal excision (TME); we observe the parasympathetic nerve to the distal colon can be served as one of useful markers for precisely locating the posterior dissection plane in TME. From October 2006 to January 2008, 26 patients underwent TME for rectal cancer. The dissections of the parasympathetic nerves to the distal colon were performed and the relationship of these nerves to the prehypogastric nerve fascia was observed. Some parasympathetic nerves ran upwards and lay anteromedial to the hypogastric nerves. In the avascular space between prehypogastric nerve fascia and the fascia propria of the rectum, the prehypogastric nerve fascia enveloped parasymphathetic nerve up to the fascia propria of rectum. The parasympathetic nerve to the distal colon is evident between the fascia propria of the rectum and the prehypogastric nerve fascia. As the precise dissection plane of TME lay between the fascia propria of the rectum and the prehypogastric nerve fascia, these nerves could be served as useful marker for precisely locating the posterior dissection plane in TME.