How is surgery for proctitis and anusitis performed?

Updated: Mar 27, 2020
  • Author: David E Stein, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

Good surgical technique is imperative. In the performance of a pelvic dissection, knowing the anatomic planes and adjacent structures is important for avoiding injury.

The presacral nerves are on the anterior aspect of the sacrum. These nerves usually can be identified at the sacral promontory, approximately 1 cm lateral to the midline.

Be aware of the parasympathetic innervation to the urinary and genital organs and the rectum at the lateral edges of the rectum, near the lateral stalks. The parasympathetic nerve supply in this area is from the nervi erigentes. Dissection that is too lateral will likely affect this nerve supply.

Maintain the correct plane of dissection along the posterior rectum. Along the same principles of total mesorectal excision, the plane outside the mesorectum but above the presacral fascia is the correct plane to dissect. Dissection that is too anterior results in entry into the mesorectum. Dissection that is too deep through the presacral fascia risks presacral bleeding.

Maintain the correct plane of dissection along the anterior rectum. Clearly, important structures exist in both females (vagina) and males (prostate, seminal vesicles).

Remain cognizant of the course of the ureters along the lateral rectum when dissection enters into the pelvis.


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