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Aytac E, Sökmen S, Öztürk E, Rencüzoğulları A, Sungurtekin U, Akyol C, Demirbaş S, Leventoğlu S, Karakayalı F, Korkut MA, Öncel M, Gülcü B, Canda AE, Eray İC, Özgen U, Ersöz Ş, Özer T, Özerhan İH, Bozbıyık O, Haksal M, Oral BM. Management and Morbidity of Major Pelvic Hemorrhage in Complex Abdominopelvic Surgery. Eur Surg Res 2023; 64:390-397. [PMID: 37816336 DOI: 10.1159/000534477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/04/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Hemorrhage is a challenging complication of pelvic surgery. This study aimed to analyze the causes, management, and factors associated with morbidity in patients experiencing major pelvic hemorrhage during complex abdominopelvic surgery. METHODS Patients who had major intraoperative pelvic hemorrhage during complex abdominopelvic surgery at 11 tertiary referral centers between 1997 and 2017 were included. Patient characteristics, management strategies to control bleeding, short- and long-term postoperative outcomes were evaluated retrospectively. RESULTS There were 120 patients with a mean age of 56.6 ± 2.4 years and a mean BMI of 28.3 ± 1 kg/m2. While 104 (95%) of the patients were operated for malignancy, 16 (5%) of the patients had surgery for a benign disease. The most common bleeding site was the presacral venous plexus 90 (75%). Major pelvic hemorrhage was managed simultaneously in 114 (95%) patients. Electrocauterization 27 (23%), pelvic packing 26 (22%), suturing 7 (6%), thumbtacks application 7 (6%), muscle welding 4 (4%), use of energy devices 2 (2%), and topical hemostatic agents 2 (2%) were the management tools. Combined techniques were used in 43 (36%) patients. Short-term morbidity and mortality rates were 48 (40%) and 2 (2%), respectively. High preoperative CRP levels (p = 0.04), history of preoperative radiotherapy (p = 0.04), longer bleeding time (p = 0.006), and increased blood transfusion (p = 0.005) were the factors associated with postoperative morbidity. CONCLUSION Postoperative morbidity related to major pelvic hemorrhage can be reduced by optimizing the risk factors. Prehabilitation prior to surgery to moderate inflammatory status and prompt action with proper technique to control major pelvic hemorrhage can prevent excessive blood loss in complex abdominopelvic surgery.
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Affiliation(s)
- Erman Aytac
- Acibadem Mehmet ali Aydinlar University, Istanbul, Turkey
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tahir Özer
- SBU Gulhane Education and Training Hospital, Ankara, Turkey
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Casal Núñez JE, Vigorita V, Ruano Poblador A, Gay Fernández AM, Toscano Novella M&A, Cáceres Alvarado N, Pérez Dominguez L. Presacral venous bleeding during mobilization in rectal cancer. World J Gastroenterol 2017; 23:1712-1719. [PMID: 28321171 PMCID: PMC5340822 DOI: 10.3748/wjg.v23.i9.1712] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/26/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.
METHODS A review of the databases MEDLINE® and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.
RESULTS This is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.
CONCLUSION A series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.
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Casal Núñez JE, Pérez Domínguez L, Vigorita V, Ruano Poblador A. Efficacy of rectus muscle fragment welding in the control of presacral venous bleeding. ANZ J Surg 2016; 88:182-184. [PMID: 27566692 DOI: 10.1111/ans.13687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 06/01/2016] [Accepted: 06/10/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND The incidence of presacral venous bleeding during rectal resection is low, but this complication can be severe and even lethal. Occasionally, the traditional methods - such as pelvic gauze packing and the use of metallic thumbtacks - are not effective. When combined with their complications and difficulties, these failures have resulted in numerous creative procedures with which to control this complication. In 1994, the indirect electrocoagulation method, which is performed via a fragment of the rectus abdominis muscle of the abdomen, was introduced to control presacral venous bleeding. METHODS From January 2002 to December 2015, five of 872 patients with rectal cancer and one patient with rectal metastasis of gastric cancer developed presacral venous bleeding, and this technique was used in every case. RESULTS Haemostasis was permanent in all cases. There were no complications such as infection or rebleeding. CONCLUSION In our experience, indirect electrocoagulation via a fragment of the rectus abdominis muscle of the abdomen is a rapid, easily executed and effective method for controlling presacral venous bleeding during rectal resection.
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Affiliation(s)
| | | | - Vincenzo Vigorita
- Unit of Coloproctology, Department of Surgery, Álvaro Cunqueiro Hospital, Vigo, Spain
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Rajiv S, Rodgers S, Bassiouni A, Vreugde S, Wormald PJ. Role of crushed skeletal muscle extract in hemostasis. Int Forum Allergy Rhinol 2015; 5:431-4. [DOI: 10.1002/alr.21489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/13/2014] [Accepted: 12/23/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Sukanya Rajiv
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
| | - Susan Rodgers
- Department of Haematology; SA Pathology; Adelaide Australia
| | - Ahmed Bassiouni
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
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Intraoperative bleeding and haemostasis during pelvic surgery for locally advanced or recurrent rectal cancer: a prospective evaluation. Tech Coloproctol 2014; 18:887-93. [PMID: 24890577 DOI: 10.1007/s10151-014-1150-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 04/12/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study aimed to prospectively quantify the frequency of serious bleeding during pelvic surgery for locally advanced or recurrent rectal cancer and review the surgical methods used to control this. METHODS Consecutive cases of pelvic surgery for curative resection of locally advanced or recurrent rectal cancer were prospectively evaluated over a nine-month period. The procedures undertaken included multivisceral resections, sacrectomies or ultra-low anterior resections. Multivisceral resections were defined as pelvic exenterations, extra-levator abdominoperineal resections (ELAPER) and recurrent anterior resections. The primary endpoint was the proportion of patients sustaining major blood loss, defined as ≥1,000 ml. The secondary endpoint was the blood transfusion rate. Haemostatic adjunct use was recorded. RESULTS Twenty-six patients underwent surgery, comprising 11 pelvic exenterations, 3 ELAPERs, 1 recurrent anterior resection, 5 abdominosacral resections and 6 ultra-low anterior resections. The median intraoperative blood loss was 1,250 ml with 53.8 % of the patients sustaining a loss ≥1,000 ml. Fifty per cent of patients required a blood transfusion within 24 h, and one or more haemostatic adjuncts were necessary in 50 % of the cases. Adjuncts used included a fibrinogen/thrombin haemostatic agent in 38.5 % of patients, temporary intraoperative pelvic packing in 11.5 % of patients and preoperative internal iliac artery embolization in 7.7 % of patients. CONCLUSIONS This patient group is at a high risk of intraoperative haemorrhage, and such patients are high consumers of blood products. Haemostatic adjunct use is often necessary to minimize blood loss. We describe our local algorithm to assist in the assessment and intraoperative management of these challenging cases.
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Celentano V, Ausobsky JR, Vowden P. Surgical management of presacral bleeding. Ann R Coll Surg Engl 2014; 96:261-5. [PMID: 24780015 PMCID: PMC4574406 DOI: 10.1308/003588414x13814021679951] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Presacral venous bleeding is an uncommon but potentially life threatening complication of rectal surgery. During the posterior rectal dissection, it is recommended to proceed into the plane between the fascia propria of the rectum and the presacral fascia. Incorrect mobilisation of the rectum outside the Waldeyer's fascia can tear out the lower presacral venous plexus or the sacral basivertebral veins, causing what may prove to be uncontrollable bleeding. METHODS A systematic search of the MEDLINE(®) and Embase™ databases was performed to obtain primary data published in the period between 1 January 1960 and 31 July 2013. Each article describing variables such as incidence of presacral venous bleeding, surgical approach, number of cases treated and success rate was included in the analysis. RESULTS A number of creative solutions have been described that attempt to provide good tamponade of the presacral haemorrhage, eliminating the need for second operation. However, few cases are reported in the literature. CONCLUSIONS As conventional haemostatic measures often fail to control this type of haemorrhage, several alternative methods to control bleeding definitively have been described. We propose a practical comprehensive classification of the available techniques for the management of presacral bleeding.
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Affiliation(s)
- V Celentano
- Bradford Teaching Hospitals NHS Foundation Trust, UK
| | - JR Ausobsky
- Bradford Teaching Hospitals NHS Foundation Trust, UK
| | - P Vowden
- Bradford Teaching Hospitals NHS Foundation Trust, UK
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Holman FA, van der Pant N, de Hingh IHJT, Martijnse I, Jakimowicz J, Rutten HJ, Goossens RHM. Development and clinical implementation of a hemostatic balloon device for rectal cancer surgery. Surg Innov 2013; 21:297-302. [PMID: 24172167 DOI: 10.1177/1553350613507145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Surgery for locally advanced and recurrent rectal carcinoma can be associated with major blood loss. OBJECTIVE We developed a promising technique using a hemostatic balloon to stop uncontrollable bleeding. DESIGN Models were developed using pelvic magnetic resonance imaging scans, and these models were tested in a cadaveric study. Eventually a model was tested in a clinical setting. The Hemostatic Balloon Device was placed in patients in whom during surgery uncontrollable bleeding from the venous presacral plexus occurred. SETTINGS A tertiary referral hospital for locally advanced and recurrent rectal cancer. PATIENTS Patients receiving multimodality treatment for primary or recurrent locally advanced rectal carcinomas. MAIN OUTCOME MEASURES First the developed prototypes were tested in a cadaveric study where the developing pressure on the pelvic wall was measured. Second, the Hemostatic Balloon Device was placed in patients in whom during surgery uncontrollable bleeding from the venous presacral plexus occurred. RESULTS The balloon was used in 9 patients. Median volume of blood loss was 7500 mL. In 8 patients treatment with the hemostatic balloon was successful. In 1 patient the balloon was dislocated cranially and the pelvis was packed with surgical gauzes. LIMITATIONS These first results are promising but further research is needed to evaluate how effective the balloon is in controlling massive bleeding during rectal cancer surgery. Future perspectives include a possibly thinner silicon rubber that can be stretched more easily with a lower inflated volume. DISCUSSION The hemostatic balloon is a new and promising technique for accomplishing hemostasis with controllable pressure on the pelvic cavity wall and can be removed without the need for a second laparotomy.
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Affiliation(s)
| | | | | | | | | | | | - Richard H M Goossens
- Delft University of Technology, Delft, Netherlands Erasmus Medical Center, Rotterdam, Netherlands
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Saurabh S, Strobos EH, Patankar S, Zinkin L, Kassir A, Snyder M. The argon beam coagulator: a more effective and expeditious way to address presacral bleeding. Tech Coloproctol 2012; 18:73-6. [PMID: 23111401 DOI: 10.1007/s10151-012-0915-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 10/01/2012] [Indexed: 12/20/2022]
Abstract
Presacral bleeding is a dreaded complication of pelvic surgery. Rapid and effective control of such bleeding is important to avoid potentially life-threatening outcomes. Various methods for controlling presacral bleeding, all with only limited success, have been described in the literature. We report the alternative technique of using the argon beam coagulator (ABC) to control presacral bleeding. We demonstrate its efficacious use in both open surgery and a laparoscopic case. Our approach involved applying an argon beam at bone setting directly to the bleeders and using a "point and shoot" technique. We found that ABC is a simpler, equally effective and expeditious way of addressing presacral bleeding. To the best of our knowledge, there has been only one previously reported case in the literature of the use of ABC to control presacral bleeding.
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Affiliation(s)
- S Saurabh
- General Surgery Resident (PGY4), Drexel University College of Medicine, Philadelphia, PA, 19102, USA,
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Use of absorbable hemostatic gauze with medical adhesive is effective for achieving hemostasis in presacral hemorrhage. Am J Surg 2012; 203:e5-8. [PMID: 22450029 DOI: 10.1016/j.amjsurg.2010.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 06/30/2010] [Accepted: 06/30/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Management of presacral hemorrhage is always challenging. Herein we describe the use of an absorbable hemostatic gauze with α-cyanoacrylate medical adhesive to achieve hemostasis. METHODS In this study, we conducted total mesorectal excision for the treatment of rectal cancer in 258 patients from March 2006 to May 2009. Intraoperative presacral hemorrhage developed in 5 (2%) patients during rectal mobilization. RESULTS In these 5 patients, massive bleeding could not be controlled by pressure and pelvic packing with gauze. An absorbable hemostatic gauze spread with medical adhesive was compressed onto the bleeding vessel for at least 20 minutes. Hemostasis was achieved successfully and was maintained during the surgery. Patients recovered uneventfully and no postoperative events were noted. CONCLUSIONS The use of an absorbable hemostatic gauze with medical adhesive is a simple and effective method for achieving hemostasis when massive presacral hemorrhage occurs. However, its effectiveness needs to be confirmed in a controlled study in a properly selected patient population.
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Casal Nuñez JE, García Martinez MT, Ruano Poblador A, Sánchez Conde JA, Pampín Medela JL, Moncada Iribarren E, De Sanildefonso Pereira A. [Presacral haemorrhage during rectal cancer resection: morphological and hydrodynamic considerations]. Cir Esp 2012; 90:243-7. [PMID: 22405887 DOI: 10.1016/j.ciresp.2011.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 11/14/2011] [Accepted: 11/17/2011] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Our aim is to identify the location and size of the anterior foramina of sacral vertebral bodies and analyse the haemodynamic variables that could influence the haemorrhagic severity of the injury of the presacral venous plexus. MATERIALS AND METHODS Using computed axial tomography the morphological data of 70 sacral bones in 67 patients with rectal cancer were recorded, as well as measuring the height between the vena cava and S5. After transfemoral catheterisation the inferior vena cava pressure was recorded in 10 patients with rectal cancer. Hydrodynamic principles, according to Bernoulli's Law, were applied to calculate sacral venous plexus pressure, and the flow rate according to the calibre of a hypothetical venous injury. RESULTS The maximum diameter ranged from 0.5mm to 4mm in 22% of the cases. All foramina of 2 or more millimetres were located in the S4-S5 region. Sacral plexus venous pressure in lithotomy was almost double the inferior vena cava pressure in normal position. Blood flow ranged from 498 to 1,994 ml/min for injuries of sizes between 2 and 4mm, respectively. CONCLUSIONS Larger calibre foramina are found in vertebral bodies of S4-S5. Venous injury at these levels can reach a flow rate of 2 l/min.
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Casal Núñez JE, Martínez MTG, Poblador AR. [Electrocoagulation on a fragment of anterior abdominal rectal muscle for the control of presacral bleeding during rectal resection]. Cir Esp 2012; 90:176-9. [PMID: 22342004 DOI: 10.1016/j.ciresp.2011.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 10/19/2011] [Accepted: 10/23/2011] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Presacral venous haemorrhage during rectal movement is low, but is often massive, and even fatal. Our objective is the "in vitro" determination of the results of electrocoagulation applied to a fragment of muscle on the sacral bone surface during rectal resection due to a malignant neoplasm of the rectum. MATERIAL AND METHOD Single-pole coagulation was applied "in vitro" with the selector at maximum power on a 2×2 cms muscle fragment, applied to the anterior side of the IV sacral vertebra until reaching boiling point. The method was used on 6 patients with bleeding of the presacral venous plexus. RESULTS In the "in vitro" study, boiling point was reached in 90 seconds from applying the single-pole current on the muscle fragment. Electrocoagulation was applied to a 2×2 cm rectal muscle fragment in 6 patients with presacral venous haemorrhage, using pressure on the surface of the presacral bone, with the stopping of the bleeding being achieved in all cases. CONCLUSIONS The use of indirect electrocoagulation on a fragment of the rectus abdominis muscle is a straightforward and highly effective technique for controlling presacral venous haemorrhage.
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Affiliation(s)
- José Enrique Casal Núñez
- Hospital Meixoeiro, Complejo Hospitalario Universitario, Unidad de Coloproctología, Vigo, España.
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Pelvic packing: a rescue treatment for severe presacral hemorrhage. Eur Surg 2011. [DOI: 10.1007/s10353-011-0013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Joseph P, Perakath B. Control of presacral venous bleeding with helical tacks on PTFE pledgets combined with pelvic packing. Tech Coloproctol 2010; 15:79-80. [PMID: 20976513 DOI: 10.1007/s10151-010-0650-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 10/06/2010] [Indexed: 02/07/2023]
Abstract
Persistent and torrential bleeding from presacral veins is an uncommon complication during rectal resection. Control of bleeding is often difficult. We report an effective technique for controlling sacral bleeding using endoscopic helical tackers applied over pledgets of expanded polytetrafluoroethylene.
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Affiliation(s)
- P Joseph
- Department of General Surgery Unit IV, Christian Medical College, Vellore 632 004, India.
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Hammond KL, Margolin DA. Surgical hemorrhage, damage control, and the abdominal compartment syndrome. Clin Colon Rectal Surg 2010; 19:188-94. [PMID: 20011320 DOI: 10.1055/s-2006-956439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The morbidity and mortality associated with surgical hemorrhage are considerable, particularly when relaparotomy is necessary. This complication can usually be avoided with comprehensive preoperative patient evaluation and meticulous surgical technique. The damage control sequence is a useful surgical strategy when severe intraoperative coagulopathy or hemodynamic instability is present. Abdominal compartment syndrome is a potentially lethal phenomenon that can occur following laparotomy or large-volume fluid resuscitation, or both. Early recognition and intervention are critical to survival of the patient when this syndrome occurs.
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Affiliation(s)
- Kerry L Hammond
- Department of Colon and Rectal Surgery, The Ochsner Clinic Foundation, New Orleans, LA 70121, USA
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Combined oxidized cellulose and cyanoacrylate glue in the management of severe presacral bleeding. Surg Today 2009; 39:1016-7. [PMID: 19882330 DOI: 10.1007/s00595-009-4012-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 04/16/2009] [Indexed: 02/06/2023]
Abstract
Massive presacral bleeding is a severe complication during a resection of the rectum. The combination of oxidized cellulose and cyanoacrylate glue can quickly control presacral bleeding. This report presents nine cases since 2002 of presacral hemorrhage treated using this method. There was no recurrent bleeding during the postoperative period. All patients were followed for 6-12 months, and there were no other complications reported.
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D'Ambra L, Berti S, Bonfante P, Bianchi C, Gianquinto D, Falco E. Hemostatic step-by-step procedure to control presacral bleeding during laparoscopic total mesorectal excision. World J Surg 2009; 33:812-5. [PMID: 19093145 DOI: 10.1007/s00268-008-9846-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND A new procedure of hemostasis during laparoscopic total mesorectal excision is described. METHODS In our surgical department, from January 2004 to December 2007, 128 patients underwent laparoscopic total mesorectal excision. Among them, 47 patients underwent laparoscopic anterior resection after preoperative radiotherapy, 68 patients underwent laparoscopic anterior resection without preoperative radiotherapy, and 13 patients underwent laparoscopic abdominal perineal amputation. RESULTS In seven laparoscopic rectal surgery cases, we encountered unstoppable presacral bleeding, not amenable by conventional hemostatic solutions. In these cases we applied a simple staging hemostatic procedure. We first performed local compression: tamponing with a small gauze or absorbable fabric hemostat. If bleeding did not stop, we localized an epiploic or omental scrap and excised it by using bipolar forceps and use it as a plug on the tip of a grasping forceps. This plug is then put on the bleeding source and monopolar coagulation is applied by electrified dissecting forceps through the interposed grasping forceps. If bleeding did not stop, we used a little scrap of bovine pericardium graft and tacked it to the bleeding site using endoscopic helicoidal protack. CONCLUSIONS Our experience suggests that this hemostatic step-by-step procedure is a valid option to control persistent presacral hemorrhages.
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Affiliation(s)
- Luigi D'Ambra
- Division of Surgery, S. Andrea Hospital, 19100, La Spezia, Italy.
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Mlynček M, Uharček P, Obert A. The Management of a Life-Threatening Pelvic Hemorrhage in Obstetrics and Gynecology. J Gynecol Surg 2005. [DOI: 10.1089/gyn.2005.21.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Miloš Mlynček
- Department of Obstetrics and Gynecology, Nitra Hospital, Nitra, Slovakia
| | - Peter Uharček
- Department of Obstetrics and Gynecology, Nitra Hospital, Nitra, Slovakia
| | - Adrián Obert
- Department of Obstetrics and Gynecology, Nitra Hospital, Nitra, Slovakia
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Wydra D, Emerich J, Dudziak M, Ciach K, Marciniak A. Emergency pelvic packing to control massive intraoperative bleeding during pelvic posterior exenteration. Eur J Obstet Gynecol Reprod Biol 2005; 117:247-8. [PMID: 15541867 DOI: 10.1016/j.ejogrb.2004.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2004] [Indexed: 11/25/2022]
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Wydra D, Emerich J, Ciach K, Dudziak M, Marciniak A. Surgical pelvic packing as a means of controlling massive intraoperative bleeding during pelvic posterior exenteration--a case report and review of the literature. Int J Gynecol Cancer 2004; 14:1050-4. [PMID: 15361227 DOI: 10.1111/j.1048-891x.2004.14553.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This is a report of a case of gynecological hemorrhage after a posterior pelvic exenteration in patients with vulvar cancer treated by temporary pelvic packing at the Department of Gynecology of the Medical University in Gdańsk. The packing was successful and the sponges were removed after 24 h. Twenty-eight days after the operation, the patient was transferred to the Department of Radiotherapy for supplementary treatment. In patients with severe intraoperative hemorrhage, intra-abdominal packing has been successful as a mode of treatment.
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Affiliation(s)
- D Wydra
- Department of Gynecology, Medical University of Gdańsk, Poland.
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