Total mesorectal excision with preservation of Denonvilliers' fascia (iTME) based on membrane anatomy

Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
H B Wei, J F Fang

Abstract

Total mesorectal excision (TME) has been advocated as the golden standard of mid-low rectal cancer surgery for nearly 30 years. However, the complication of postoperative urinary and sexual dysfunctions due to intraoperative nerve injury has yet to be improved. Based on the concept of membrane anatomy, we carried out a systematic study on the important membrane anatomical structure anterior to the rectum--Denonvilliers' fascia. From multiple aspects including anatomy, physiology, histochemistry and surgical practice, we verified the importance of Denonvilliers' fascia for TME surgery in prevention of intraoperative nerve injury and postoperative urogenital dysfunction. Moreover, based on anatomical study of the surgical marker line of Denonvilliers' fascia (Wei's line) and surgical plane, we proved that total mesorectal excision with preservation of Denonvilliers' fascia (iTME) was feasible and practical. Therefore, we conducted a large multicentric randomized controlled trial (RCT). The mid-term result demonstrated that compared with traditional TME surgery, iTME was more effective in reducing the incidence of postoperative urinary and sexual dysfunctions in male patients with mid-low rectal cancer, without sacrifice of short-...Continue Reading

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Related Papers

Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
H B Wei, J F Fang
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
Minimally Invasive Anatomy Group, Colorectal Cancer Committee of Chinese Medical Doctor Association, Colorectal and Anal Function Surgeons Committee of China Sexology Association
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