Denonvillier’s fascia: to take it or not to take it

Surgery video link: Case of intestinal occlusion that was found in a patient after obesity surgery

Charles-Pierre Denonvilliers was a 19th-century French anatomist, who described the retroprostatic fascia, among other anatomic structures. This extension of the visceral fascia at the lowest part of the Douglas pouch in the male separates the prostate, seminal vesicles and urinary bladder from the extraperitoneal rectum. This structure corresponds to the rectovaginal fascia in the female.

Denonvilliers’ fascia contains the periprostatic plexus: the nervi cavernosi and corpus spongiosum nerves. An injury to the periprostatic plexus will cause parasympathetic and sympathetic lesions. The original description of the total mesorectal excision included Denonvilliers’ fascia, although it led to considerable detrimental functional outcomes as described later. Therefore, the inclusion of Denonvilliers’ fascia is still a matter of debate among the surgical community, as it has functional consequences when taken during the total mesorectal excision. Some experts will recommend preserving Denonvilliers’ fascia in the posterior and lateral tumors and including it in the specimen only in cases in which the tumor is anterior or circumferential. Here we can see how the dissection progressed anteriorly to Denonvilliers’ fascia, exposing the seminal vesicles and the prostate.