Pelvic connective tissues in patients with rectalprolapse: LTP01

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Aim:The aetiology of rectalprolapse is not well understood, compounded by lack of understanding of connective tissue topography. We aimed to assess this in the Douglas pouch of patients with rectalprolapse.Method:After obtaining ethics approval, patients undergoing laparoscopic ventral rectopexy had the pouch of Douglas (rectovesical pouch in men) excised and histologically staining with Haematoxylin and Eosin, Masson Trichrome and Elastin Van Gieson. A morphological assessment of the tissues was then undertaken.Results:Specimens on 18 patients were obtained. Pelvic support for the rectum is partlyprovided via fascialprojections running through the mesorectum to blend continuously with the endopelvic fascia. Superiorly these blend and are intimately associated with a collagenous layer lying immediately beneath the peritoneal reflection. Elastic fibres arepresent both within the sub peritoneal collagenous layer and running with the fascialprojections towards the endopelvic fascia and appear to have a mature morphology.Conclusion:These data outline a mechanism of fascial support for the rectum, notpreviously described, mediated by fascial bridges composed of collagen and elastin. Thepresence of which suggests that these are long standing structures. The collagenous composition of this supportive network may be abnormal in patients withprolapse disorders and merits further studies.

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