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A Systematic Review of Varying Definitions and the Clinical Significance of Fredet's Fascia in the Era of Complete Mesocolic Excision.

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Published version
Peer-reviewed

Repository DOI


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Authors

Brachini, Gioia 
Matteucci, Matteo 
Tebala, Giovanni Domenico  ORCID logo  https://orcid.org/0000-0001-7152-4096

Abstract

BACKGROUND: Fredet's fascia represents a crucial landmark for vascular surgical anatomy, especially in minimally invasive complete mesocolic excision (CME) for right-sided colon adenocarcinoma. Fredet's fascia allows access to the gastrocolic trunk of Henle (GCTH), the most critical step in both open and minimally invasive right-sided CME techniques. Despite this, a recent workshop of expert surgeons on the standardization of the laparoscopic right hemicolectomy with CME did not recognize or include the term of Fredet's fascia or area. Hence, we undertook a systematic review of articles that include the terms "Fredet's fascia or area", or synonyms thereof, with special emphasis on the types of articles published, the nationality, and the relevance of this area to surgical treatments. METHODS: We conducted a systematic review up to 15 July 2022 on PubMed, WOS, SCOPUS, and Google Scholar. RESULTS: The results of the study revealed that the term "Fredet's fascia" is poorly used in the English language medical literature. In addition, the study found controversial and conflicting data among authors regarding the definition of "Fredet's fascia" and its topographical limits. CONCLUSIONS: Knowledge of Fredet's fascia's surgical relevance is essential for colorectal surgeons to avoid accidental injuries to the superior mesenteric vascular pedicle during minimally invasive right hemicolectomies with CME. In order to avoid confusion and clarify this fascia for future use, we suggest moving beyond the use of the eponymous term by using a "descriptive term" instead, based on the fascia's anatomic structure. Fredet's fascia could, therefore, be more appropriately renamed "sub-mesocolic pre-duodenopancreatic fascia".

Description

Peer reviewed: True


Acknowledgements: The authors would like to give special thanks to Mauro Vaccarezza, Anatomy for proofreading this article. We would also like to thank Elisa Cordaro, Sapienza University of Rome, for drawing and coloring Figure 4.

Keywords

CME, colon adenocarcinoma, hemicolectomy, laparoscopy, right colon

Journal Title

J Clin Med

Conference Name

Journal ISSN

2077-0383
2077-0383

Volume Title

12

Publisher

MDPI AG