title: Circular suture ligation of presacral venous plexus to control presacral venous bleeding during rectal mobilization.
abstract: BACKGROUND
  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.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  Bleeding 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.
  
  
  CONCLUSIONS
  Our 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.
authors.affiliation: Department of General Surgery, Shandong University Qilu Hospital, Jinan, Shandong, China.
authors.forename: Jinbo
authors.initials: J
authors.lastname: Jiang
authors.forename: Xuemei
authors.initials: X
authors.lastname: Li
authors.forename: Yanlei
authors.initials: Y
authors.lastname: Wang
authors.forename: Hui
authors.initials: H
authors.lastname: Qu
authors.forename: Zutao
authors.initials: Z
authors.lastname: Jin
authors.forename: Yong
authors.initials: Y
authors.lastname: Dai
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012447:Sacrum; D013536:Suture Techniques; D014680:Veins