Distal Anterior Dissection

In male patients, the peritoneum is incised at the retrovesical reflection. Then the mobilisation is continued in the plane between the seminal vesicles and more distally the prostate and Denonvilliers' fascia. In contrast with rectal dissection for benign disease, Denonvilliers' fascia should not be divided.

In women the transverse incision is made anterior to the rectovaginal reflection. Then the plane between the rectum and vagina is developed until the pubis can be felt anteriorly. In praxis this part of dissection is often more difficult in women than in male patients. Bleeding (especially from the postvaginal venous plexus) is controlled by electrocautery.

Even nowadays sometimes there might be problems in identifying the Denonvilliers' fascia. Recently, in a histological study, Lindsey et al. reported that in rectal cancer patients the surgeons are more prone to dissect close to the bowel wall, leaving the De-nonvilliers' fascia anteriorly (on the posterior wall of the prostate) [18].

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