title: Mesenteric-Based Surgery Exploits Gastrointestinal, Peritoneal, Mesenteric and Fascial Continuity from Duodenojejunal Flexure to the Anorectal Junction--A Review.
abstract: BACKGROUND
  It is now well established that mesenteric-based colorectal surgery is associated with superior outcomes. Recent anatomic observations have demonstrated that the mesenteric organ is contiguous from the duodenojejunal to the anorectal junction. This led to similar observations in relation to associated peritoneum and fascia. The aim of this review was to demonstrate the relevance of the contiguity principle to resectional colorectal surgery.
  
  
  METHODS
  All literature in relation to mesenteric anatomy was reviewed from 1873 to the present, without language restriction.
  
  
  RESULTS
  Mesenteric-based surgery (i.e. complete mesocolic excision, total mesocolic and mesorectal excision) requires division of the peritoneal reflection (i.e. peritonotomy), and mesenteric mobilisation in the mesofascial plane. These are the fundamental technical elements of mesenterectomy. Mesenteric, peritoneal and fascial contiguity mean that in resectional surgery, these technical elements can be reproducibly applied at all levels from the origin at the superior mesenteric root, to the anorectal junction.
  
  
  CONCLUSIONS
  The goals of complete mesocolic, total mesocolic and mesorectal excision can be universally achieved at any level from duodenojejunal flexure to anorectal junction, by adopting technical elements based on mesenteric, peritoneal and fascial contiguity.
authors.affiliation: Department of Surgery, University Hospital Limerick, Graduate Entry Medical School, Limerick, Ireland.
authors.forename: J Calvin
authors.initials: JC
authors.lastname: Coffey
authors.forename: Mary
authors.initials: M
authors.lastname: Dillon
authors.forename: Rishabh
authors.initials: R
authors.lastname: Sehgal
authors.forename: Peter
authors.initials: P
authors.lastname: Dockery
authors.forename: Fabio
authors.initials: F
authors.lastname: Quondamatteo
authors.forename: Dara
authors.initials: D
authors.lastname: Walsh
authors.forename: Leon
authors.initials: L
authors.lastname: Walsh
mesh_terms: D001003:Anal Canal / Q000033:anatomy & histology / Q000601:surgery; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000033:anatomy & histology / Q000601:surgery*; D004210:Dissection; D004386:Duodenum / Q000033:anatomy & histology / Q000601:surgery; D005205:Fascia / Q000033:anatomy & histology; D000071938:Fasciotomy; D006801:Humans; D007583:Jejunum / Q000033:anatomy & histology / Q000601:surgery; D008643:Mesentery / Q000033:anatomy & histology / Q000601:surgery*; D010537:Peritoneum / Q000033:anatomy & histology / Q000601:surgery; D012007:Rectum / Q000033:anatomy & histology / Q000601:surgery*