[Controversy over the fascial anatomy of the female anterior rectal space: Does Denonvilliers' fascia exist?].

The existence of Denonvilliers' fascia (DF) within the female anterior rectal space remains a subject of persistent anatomical and surgical controversy. Originally described in the male pelvis, DF has not been consistently identified or defined in women. A subset of anatomical investigations-predominantly histological analyses of fresh-female cadavers and simulated total mesorectal excision (TME) planes-argues that no independent, collagen-dense fascial lamina exists between the posterior vaginal wall and the anterior rectal wall; the structure surgically labeled "DF" is interpreted as an iatrogenic split within the vaginal adventitia. Conversely, evidence derived from high-resolution colloidin-embedded serial histology, fetal three-dimensional computer-assisted reconstruction, and magnetic resonance imaging in Mayer-Rokitansky-Küster-Hauser syndrome (a natural vagina-absent model) supports the ontogenetic and morphological independence of a discernible rectovaginal fascial layer. Rather than engaging in nominalist discourse, we contend that the critical clinical consideration is the anatomical behavior of this fascia-like layer during anterior rectal mobilization. Adoption of a "partial preservation of DVF" dissection strategy-incising the peritoneal reflection 0.5-1.0 cm anterior to the peritoneal reflection, dissecting along the ventral aspect of the DF and transecting it 3-5 cm distally-facilitates unimpeded, blood-sparse exposure of the avascular plane between DF and the rectal proper fascia. This approach ensures complete mesorectal envelope removal while minimizing trauma to the neurovascular bundles embedded within the inferolateral extensions of DF, thereby optimizing oncological clearance for anterior-wall rectal cancers without compromising pelvic autonomic function.