Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, 75013, Paris, France.
Ecole de Chirurgie, Assistance-Publique Hôpitaux de Paris, 7, rue du Fer à Moulin, 75005, Paris, France.
Surg Radiol Anat. 2022 Jun;44(6):891-898. doi: 10.1007/s00276-022-02955-2. Epub 2022 May 23.
The placement of posterior mesh during pelvic organ prolapse laparoscopic surgery has been incriminated as responsible for postoperative adverse outcomes such as digestive symptoms, chronic pelvic pain, and sexual dysfunction. These complications may be related to neural injuries that occur during the fixation of the posterior mesh on the levator ani muscle.
The aim of our study was to describe the course of the autonomic nerves of the pararectal space and their anatomical relationship with the posterior mesh fixation zone on the levator ani muscle.
Twenty hemi-pelvis specimens from 10 fresh female cadavers were dissected. We measured the distance between the posterior mesh fixation zone on the levator ani, and the nearest point of adjacent structures: the hypogastric nerve, inferior hypogastric plexus, uterosacral ligament, uterine artery, and ureter. Measurements were repeated starting from the inferior hypogastric plexus.
Nerve fibers of the inferior hypogastric plexus spread out systematically above the superior aspect of the levator ani muscle. Median distance from the posterior mesh fixation zone and the inferior hypogastric plexus was around 2.8 (range 2.1-3.5) cm.
The inferior hypogastric plexus lies above the superior aspect of the levator ani muscle. A short distance between the posterior mesh fixation zone on the levator ani muscle and inferior hypogastric plexus could explain in part postoperative digestive symptoms. These observations support the development of nerve-sparing procedures for posterior mesh placement in the context of pelvic organ prolapse repair and suggest that postoperative complications could be improved by changing the fixation zone.
盆腔器官脱垂腹腔镜手术中后置网片的放置被认为是术后不良结局的原因，如消化症状、慢性盆腔疼痛和性功能障碍。这些并发症可能与在提肛肌上固定后置网片时发生的神经损伤有关。
本研究旨在描述直肠旁间隙自主神经的走行及其与提肛肌上后置网片固定区的解剖关系。
对 10 具新鲜女性尸体的 20 个半骨盆标本进行解剖。我们测量了提肛肌上后置网片固定区与相邻结构（腹下神经、下腹下丛、子宫骶韧带、子宫动脉和输尿管）最近点之间的距离。从下腹下丛开始重复测量。
下腹下丛的神经纤维在提肛肌的上表面系统地展开。后置网片固定区与下腹下丛之间的中位数距离约为 2.8cm（范围 2.1-3.5cm）。
下腹下丛位于提肛肌的上表面。提肛肌上后置网片固定区与下腹下丛之间的短距离可以部分解释术后消化症状。这些观察结果支持在盆腔器官脱垂修复中开展保留神经的后置网片放置手术，并表明通过改变固定区可以改善术后并发症。
