Efficacy of pelvic packing in maintaining hemostasis after rectal excision for cancer

Abstract

In a retrospective study, the records of 95 patients who underwent rectal resection for carcinoma were reviewed to assess the efficacy and complications of pelvic packing for hemorrhage. Heavier blood loss was noted with fixed tumors, where preoperative radiation had been given, or there had been previous pelvic surgery, compared with situations where these factors were absent. Three patients died from myocardial infarction, pulmonary embolus, and renal failure, respectively. No patients required further hemostatic measures after pack removal. Perineal wound infection or delayed perineal wound healing occurred in 22 percent and abdominal wound infection in 6 percent of the patients. There were no instances of anastomotic leak, abdominal abscess, or pelvic abscess requiring laparotomy for treatment in this series. Pelvic packing is a safe, simple, and effective procedure for patients with problematic pelvic bleeding after rectal resection.

Tamponade of Presacral Hemorrhage With Hemostatic Sponges Fixed to the Sacrum With Endoscopic Helical Tackers: Report of Two Cases

“…However, the need for second operation and risk of pelvic sepsis are important disadvantages of this procedure. 4 The classic alternative is occlusion of bleeders by insertion of thumbtacks into the sacrum. 2 We experienced numerous difficulties in their adequate application, as well as the others.…”

Surgical management of presacral bleeding

“…Pelvic packing controls PSB effectively and may be life saving; 19 multiple laparotomy pads are applied over bleeding sites and the abdomen is closed under tension. Packing has the disadvantage of requiring reoperation for removing the packs 24-48 hours later and risk of rebleeding.…”

“…When there is a fresh colorectal anastomosis, packing increases the risk of anastomotic disruption. 19 An alternative innovative method of haemostasis has been described by Remzi et al, who used the rectus abdominis muscle to tamponade PSB. 24 A 4cm  2cm  1cm piece of rectus abdominis muscle is harvested as a free flap and sewn over the bleeding area.…”

Co-suturing SURGICEL® and colonic fat to achieve hemostasis in presacral hemorrhage

“…However, traditional pelvic packing has some obvious disadvantages, such as the need to remove the packs later, increased risks of infection and anastomotic disruption, and delay in wound healing [3,4]. Several other methods have also been described in the literature, and each has some limitations.…”