Total mesorectal excision (TME) in rectal cancer surgery is associated with reduced local recurrence rates. The surgical plane that is dissected in TME is between:
- A The mesorectal fascia (visceral fascia) and the parietal pelvic fascia — the avascular holy plane of Heald ✓
- B The rectal wall muscularis propria and the mesorectal fascia (visceral fascia)
- C The peritoneum and the prevertebral fascia
- D The posterior rectal wall and the presacral venous plexus
Correct answer: A. The mesorectal fascia (visceral fascia) and the parietal pelvic fascia — the avascular holy plane of Heald
Explanation
TME, as described by Bill Heald, involves sharp dissection in the areolar tissue plane between the visceral mesorectal fascia (propria fascia of the mesorectal envelope) and the parietal pelvic fascia overlying the presacral structures — termed the 'holy plane.' This preserves the intact mesorectal envelope containing all tumour-bearing lymphovascular tissue, reduces local recurrence from ~25% to <5–10%, and protects the autonomic pelvic nerves (hypogastric and pelvic plexuses) to reduce sexual and urinary dysfunction.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.