The presacral fascia lines the anterior aspect of the
sacrum
The sacrum (plural: ''sacra'' or ''sacrums''), in human anatomy, is a large, triangular bone at the base of the spine that forms by the fusing of the sacral vertebrae (S1S5) between ages 18 and 30.
The sacrum situates at the upper, back part ...
, enclosing the sacral vessels and
nerve
A nerve is an enclosed, cable-like bundle of nerve fibers (called axons) in the peripheral nervous system.
A nerve transmits electrical impulses. It is the basic unit of the peripheral nervous system. A nerve provides a common pathway for the e ...
s. It continues anteriorly as the pelvic
parietal fascia
A fascia (; plural fasciae or fascias; adjective fascial; from Latin
Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (t ...
, covering the entire
pelvic cavity.
The presacral fascia is limited postero-inferiorly, as it fuses with the mesorectal fascia, lying above the
levator ani muscle, at the level of the anorectal junction. These two fascias have been erroneously confused, though they are in fact, separate anatomical entities. The colloquial term, among colo-rectal surgeons, for this inter-fascial plane, is known as the holy plane of dissection first coined by Bill Heald. During rectal
surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
and
mesorectum excision, dissection along the avascular alveolar plane between these two fascias, facilitates a straightforward dissection and preserves the sacral vessels and
hypogastric nerves.
Waldeyer's fascia (a.k.a. rectosacral fascia) originates from the presacral parietal fascia at the S2 to S4 level fusing with the rectal visceral fascia at the posterior aspect of the rectum. Waldeyer's fascia divides the retrorectal space into a superior and inferior compartments.
Identification and preservation of the presacral fascia is of fundamental importance in preventing complications and reducing local recurrences of
rectal cancer. Hence attention to this anatomy is essential in contemporary rectal surgery.
History
The mesorectal fascia, also known as the fascia propria or the pelvic visceral fascia, has been originally described as the fascia recti in Waldeyer's publication, Das Becken. Fascia recti is also a term commonly used among French surgeons to describe the mesorectal fascia.
Confusingly, fascia recti is described in some anatomy books, referring to the fascia of the
rectus abdominis muscle.
References
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Fascia