6533b857fe1ef96bd12b451c

RESEARCH PRODUCT

Die laterale Dissektion des Mesorektums ; ein Risiko für den Plexus hypogastricus inferior

subject

description

Lateral mesorectal dissection may injure parasympathetic and sympathetic pelvic nerves and a partial or complete lesion of the autonomic pelvic nerves leads to urogenital dysfunctions affecting patient’s quality of life after rectum resection for rectal carcinoma. The aim of the present prospective study was to clarify the significance for nerve damage during lateral dissection based on standardized assessment parameters. 15 Patients underwent total mesorectal excision for rectal carcinoma (UICC I/II/III/IV: 1/5/3/6). Within the scope of the stanardized intraoperative data collection it was demonstrated, whether a complete preservation of the autonomie pelvic nerves was successful. In 11 patients the so called lateral ligaments were resected and immunostained for the assessment of nerval structures and in four patients with multivisceral resection the lateral resection margins were evaluated. The results were linked to the results of pelvic autonomie nerve stimulation with intraoperative bladder monitoring and with postoperative bladder function. During lateral dissection rectal branches from the pelvic plexus were dissected (median 3, range 1-10 nerval fibers). In 5 of 11 patients ganglia cells were dissected (median 21, range 2 -46 per cross section). In 4 patients with multivisceral resection up to 500 ganglionic cells per cross section were counted unilaterally. Patients without resection of parasympathetic tissue (ganglionic cells) during lateral dissection showed better functional results. The link of resection of parasympathetic tissue (ganglia cells) during lateral dissection showed poor results for intraoperative neuromonitoring and postoperative bladder function. To summarize our findings, lateral dissection is a zone of high-risk for autonomie nerve injury. Therfore dissection should be carried out immediately to the rectum to prevent nerve damage.