Contribution to the surgical anatomy of the ligaments of the rectum

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 map influence the surgical practice. METHODS: From 1994 to 1 998 we examined 27 fresh cadavers and fire embalmed pelves. We performed al l dissections with a technique similar to that used for the surgical mobili zation of the rectum. RESULTS: The lateral Ligaments of the rectum are trap ezoid structures originating from mesorectum and are anchored to the endope lvic 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 d oes not contain important structures; 2) the inferior hypogastric plexus an d the urogenital bundle; and 3) the lateral neurovascular pedicle of the re ctum that comprises the nervi recti and the middle rectal artery, both runn ing under the lateral ligament, although at different angles. CONCLUSION: A t the point of insertion into the endopelvic fascia, the lateral ligaments nm close to the urogenital bundle. Nevertheless, the dissection at its atta chment: is safe if the urogenital bundle is kept under visual control.