Anatomical Study of Fascial Planes Relevant to Laparoscopic Gastrointestinal Surgery: A One-Year Observational Study at PMCH, Patna

Abstract

Background: Precise understanding of facial planes is fundamental for safe and effective laparoscopic gastrointestinal
surgery. Facial planes guide surgical dissection, minimize vascular injury, reduce operative complications, and facilitate
oncological clearance. Inadequate anatomical knowledge may result in inadvertent bowel injury, hemorrhage, and
postoperative morbidity.
Objective: To evaluate the anatomical characteristics and surgical relevance of facial planes encountered during
laparoscopic gastrointestinal surgeries and to assess their association with operative outcomes.
Materials and Methods: A hospital-based cross-sectional observational study was conducted in the Department of
General Surgery in collaboration with the Department of Anatomy at PMCH, Patna, over a period of one year. A total of
110 patients undergoing laparoscopic gastrointestinal procedures were included. facial planes assessed intraoperatively
included Toldt’s fascia, mesocolic plane, mesorectal plane, hepatoduodenal ligament fascia, and retroperitoneal fascial
planes. Parameters evaluated included clarity of facial plane identification, ease of dissection, operative blood loss,
operative time, inadvertent injury, and postoperative complications. Statistical analysis was performed using SPSS
version 25. Chi-square test and Student’s t-test were applied, and p-value <0.05 was considered statistically significant.
Results : Clear identification of facial planes was achieved in 82.7% of procedures. Toldt’s fascia was the most consistently
identifiable plane (76.4%), followed by mesocolic fascial planes (69.1%). Difficult fascial plane identification was
associated with increased operative time and blood loss (p <0.001). Intraoperative complications were significantly
lower in cases with well-preserved anatomical planes (p = 0.003). Intraoperative complications such as serosal injury and
postoperative complications including localized collections were more common in patients with distorted fascial anatomy.
Conclusion: Detailed understanding of facial planes significantly improves surgical precision and reduces operative
morbidity during laparoscopic gastrointestinal surgery. Routine emphasis on facial anatomy during surgical training may
enhance operative safety and clinical outcomes.