Control of presacral venous bleeding during rectal surgery

Germanos, Stylianos; Bolanis, Ioannis; Saedon, Mahmud; Baratsis, S.

doi:10.1016/j.amjsurg.2009.11.011

Cited by 37 publications

(25 citation statements)

References 13 publications

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“…Stylianos et al reported the incidence of severe presacral haemorrhage of 3.6%, and according to their literature review, there has been reported incidence of 3% to 9.4%. Unfortunately, we have no local data yet to compare (Germanos et al, 2010).In the era of laparoscopic surgery, this occurrence would become even rarer due to the magnification of the surgical field by the laparoscope whose resection is done under vision; hence, injury to the nerve and also the veins can be avoided (Arnaud et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…Theoretical proposition of haemostasis is through several mechanisms, namely, blood absorption, followed by surface interaction with proteins and platelets with activation of both the intrinsic and extrinsic pathways (Germanos et al, 2010 Ayuste et al in 2004(Harrison et al, 2003and Ayuste E, 2004.This is performed by excising a small piece of rectus muscle, holding it to a forceps, and pressing against or close to the bleeding sites, followed by electrocautery of the forceps to char the muscle piece and weld on to the bleeding sites. This process can be repeated several times until haemostasis is secured (Ayuste E, 2004).…”

Section: Discussionmentioning

confidence: 99%

“…Matrix haemostatic sealant consists of a gelatin matrix with a granular physical structure and a thrombin component.It is applicable to hard and soft tissues as well as actively bleeding sites. The gelatin matrix will act as a coating while the mixed one along thrombin component will serve as a coagulant, hence, the action of a sealant (Germanos et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The Control of Haemostasis of Presacral Venous Haemorrhage with Sterile Thumbtacks and Roller Gauze—Experience in Managing a Case of Recurrent Ovarian Cancer

Wong¹,

Kai²,

Mohamed³

et al. 2013

IJCRM

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Decision of relaparotomy is usually become a surgical dilemma as one may encounter dense adhesion before reaching the target site. This may end up with unwanted complication such as iatrogenic injury to adjacent structures as well as bleeding. This is a case of a 46-year-old lady with underlying history of ovarian carcinoma who needed to go for relaparotomy and debulking of recurrent tumour. The attempt to release adhesions was complicated with bleeding at presacral venous plexus. Due to difficulty in achieving haemostasis, bilateral internal iliac artery ligation was done. This procedure did not completely solve the bleeding, so the subsequent step to apply thumbtacks and roller gauze packing were done to create tamponade. The gauzes were removed piece by piece starting from day 8 through small incisional wound without needing to go for another laparotomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Control of Haemostasis of Presacral Venous Haemorrhage with Sterile Thumbtacks and Roller Gauze—Experience in Managing a Case of Recurrent Ovarian Cancer

Wong¹,

Kai²,

Mohamed³

et al. 2013

IJCRM

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“…Germanos et al described the successful haemostasis obtained in three cases with the combined use of a haemostatic matrix (Floseal ® ; Baxter, Hayward, CA, US) and an absorbable haemostat (Surgicel ® Fibrillar™; Ethicon, Somerville, NJ, US). 34 The matrix haemostatic sealant is applied over the bleeding site followed by the absorbable haemostat on top as a pad. The pelvis is then packed for temporary haemostasis and preventing the sealant from being washed out.…”

Section: Topical Haemostatic Agentsmentioning

confidence: 99%

Surgical management of presacral bleeding

Celentano

Ausobsky

Vowden

2014

annals

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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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“…There are also interesting reports in other clinical settings such as presacral venous bleeding during rectal surgery [4]. Again, however, there is no published experience in liver trauma patients although experimental models suggest their efficacy [5].…”

mentioning

confidence: 99%