Abstract
BackgroundPresacral venous bleeding during rectal mobilization is uncommon but potentially life-threatening. Various methods have been proposed for controlling the bleeding, but each has some obvious limitations in clinical practice. We report a simple technique that was designated as circular suture ligation. This technique was efficient in controlling presacral venous bleeding encountered during rectal mobilization. MethodsThe key point of circular suture ligation was to control the bleeding by suture ligating the venous plexus in one or more circles in the area with intact presacral fascia that surrounds the bleeding site while the bleeding site was temporarily controlled with fingertip pressure. From September 2007 to December 2011, 258 patients underwent rectal surgery in our department because of rectal cancer. Uncontrolled presacral venous bleeding with traditional methods was encountered in eight patients (3 %) with estimated blood loss from 300 to 5,000 ml. ResultsBleeding was successfully controlled in all eight patients with the circular suture ligation. None of the patients required reoperation for bleeding or other issues. No patients developed chronic pelvic pain after the operation. ConclusionsOur experience suggests that circular suture ligation of venous plexus in the area with intact presacral fascia that surrounds the bleeding site is an effective and simple technique to control presacral venous bleeding when traditional techniques fail.
Highlights
Presacral venous plexus lies posterior to the fascia propria of the rectum and underneath the presacral fascia, presenting in a ladder-like fashion (Fig. 1).[1,2,3]
Circular suture ligation was performed in all eight patients in order to control the presacral venous bleeding
The procedure of the circular suture ligation could be divided into three continuous steps
Summary
Presacral venous plexus lies posterior to the fascia propria of the rectum and underneath the presacral fascia, presenting in a ladder-like fashion (Fig. 1).[1,2,3] Because of these anatomical features, the presacral veins are lacerated when the presacral fascia is lifted or disrupted during pelvic dissection and. Presacral venous bleeding during rectal mobilization is uncommon but potentially life-threatening. Various methods have been proposed for controlling the bleeding, but each has some obvious limitations in clinical practice. We report a simple technique that was designated as circular suture ligation. This technique was efficient in controlling presacral venous bleeding encountered during rectal mobilization
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