Rectovaginal fascia: An important structure in pelvic visceral surgery? About its development, structure, and function.

Background: The existence, development, and function of the rectovaginal fascia has been discussed in literature. In women, a defect in the fascia leads to rectoceles and severe constipation. In pediatric textbooks for anorectal or urogenital surgery, however, it is not mentioned. Does the fascia exist in children?

Methods: The pelvises of 31 female and, as controls, 31 male fetuses (age from 9 weeks of gestation to newborn) were plastinated. Sections (transversal, sagittal, and frontal) were stained with azure II/ methylenblue/ basic fuchsin and viewed at a magnification of 6.5x to 80x. In addition, the authors investigated macroscopically and microscopically the rectovaginal fascia in 1 fetal and 1 adult cadaver.

Results: At the beginning of the fetal period the authors recognized the anlage of the rectovaginal fascia caudal from the rectouterine excavation. Later, a fascia of connective tissue develops. It is connected directly to areolar connective tissue at the dorsal wall of the vagina. Neurovascular bundles are situated ventrolaterally of the rectal wall. At the level of the anorectal flexure this fascia separates the rectum and the vagina.

Conclusions: Our investigations indicate that the rectovaginal fascia is completely developed in newborns, through differentiation of mesenchyme, which develops into a fascia. It protects different compartments and serves as an abutment to the rectal wall. Thus, it is important for adequate bowel emptying. For the surgeon it is a leading structure for preventing nerve damage of the autonomic nerve supply of the pelvic organs. It should be known, protected, and, if necessary, reconstructed.