title: Mobilization of the rectum: anatomic concepts and the bookshelf revisited.
abstract: BACKGROUND
  Sound surgical technique is based on accurate anatomic knowledge. In surgery for cancer, the anatomy of the perirectal fascia and the retrorectal plane is the basis for correct mobilization of the rectum to ensure clear surgical margins and to minimize the risk of local recurrence.
  
  
  METHODS
  This review of the literature on the perirectal fascia is based on a translation of the original description by Thoma Jonnesco and a later account by Wilhelm Waldeyer. The Jonnesco description, first published in 1896 in French, is compared with the German account of 1899. These were critically analyzed in the context of our own and other techniques of mobilizing the rectum.
  
  
  CONCLUSIONS
  Mobilization of the rectum for cancer can be performed along anatomic planes with minimal blood loss, preservation of the pelvic autonomic nerves and a low prevalence of local recurrence. Different techniques including total mesorectal excision are based on the same anatomic principles, however, popular words have been used to replace accepted, established terminology. In particular, the description of total mesorectal excision has been confusing because of its emphasis on the words "total" and "mesorectum." The use of the word "mesorectum" anatomically is inaccurate and the implication that total excision of all the perirectal fat contained within the perirectal fascia "en bloc" in all patients with rectal cancer will minimize local recurrence remains contentious.
authors.affiliation: Department of Colon and Rectal Surgery, The University of Sydney at Concord Hospital, New South Wales, Australia.
authors.forename: Pierre
authors.initials: P
authors.lastname: Chapuis
authors.forename: Les
authors.initials: L
authors.lastname: Bokey
authors.forename: Marius
authors.initials: M
authors.lastname: Fahrer
authors.forename: Gael
authors.initials: G
authors.lastname: Sinclair
authors.forename: Nikolai
authors.initials: N
authors.lastname: Bogduk
mesh_terms: D005205:Fascia / Q000473:pathology / Q000503:physiopathology; D000071938:Fasciotomy; D006801:Humans; D012004:Rectal Neoplasms / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D012007:Rectum / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery