The anaesthetic mixture was deposited in the sphincter complex approximately 3 cm from the anal verge through the anococcygeal
ligament into the ischiorectal fossae to the level of levator ani muscle.
Full term ANOC Anococcygeal
raphe B Bladder CCM Coccygeus muscle CL Cardinal ligament Cx Coccyx EAS External anal sphincter ICM Iliococcygeus muscle Obt Obturator internus muscle Pb Perineal body PCM Pubococcygeus muscle Pm Perineal membrane PRM Puborectalis muscle Ps Pubic symphysis PUL Pubourethral ligament R Rectum U Urethra Umb Umbilical ligament USL Uterosacral ligament Ut Uterus V Vagina Table 2: Biomechanical properties of endopelvic fascia constituents.
In accordance with the principles of a total mesorectal excision, the rectum was mobilized posteriorly down to the apex of the coccyx bone, and the anococcygeal
ligament was divided.
Muscles of the Pelvic Floor Origin Insertion Pelvic Floor Muscle Coccygeus Pelvic surface of Side of the coccyx and the ischial spine lower sacrum Levator ani (LA) Posterior surface Anococcygeal
raphe of the body of the and coccyx pubis, arcus tendineus levator ani, ischial spine Layers of the Levator Ani Illiococcygeus Arcus tendineus Anococcygeal
raphe (IC) levator ani, and and the coccyx the ischial spine (clinically called the levator plate) Pubococcygeus Posterior aspect Passes backward along (PC) of the superior the puborectalis muscle pubic ramis and inserts into the anococcygeal
and the superior surface of the coccyx.
technique has severe risks such as rectum perforation and invasion by local tumour.2
After subdermal infiltration at two sites anterior and posterior of the anal ring, the anococcygeal
ligament is deeply infiltrated with 5 ml; 8 - 10 ml are injected into both ischioanal spaces while withdrawing the needle to anaesthetise the deep nerve endings.