ORIGINAL ARTICLE Efficacy of rectus muscle fragment welding in the control of presacral venous bleeding José Enrique Casal Núñez, Lucinda Pérez Domínguez, Vincenzo Vigorita and Alejandro Ruano Poblador Unit of Coloproctology, Department of Surgery, Álvaro Cunqueiro Hospital, Vigo, Spain Key words haemorrhage, presacral bleeding, presacral veins, rectus abdominis muscle. Correspondence Ms Lucinda Pérez Domínguez, Unit of Coloproctology, Department of Surgery, Álvaro Cunqueiro Hospital, Estrada Clara Campoamor 341, Vigo 36214, Pontevedra, Spain. Email: lucindaperezdominguez@hotmail.com J. E. Casal Núñez MD, PhD; L. Pérez Domínguez MD; V. Vigorita MD; A. Ruano Poblador MD. Accepted for publication 10 June 2016. doi: 10.1111/ans.13687 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 electroco- agulation 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 con- trolling presacral venous bleeding during rectal resection. Introduction Bleeding from injury to the sacral venous plexus during mobiliza- tion of the rectum can be extensive 1 and even lethal. 2 Its inci- dence ranges between 0.24 and 8.6%, 3,4 and it has occurred during procedures such as the Hartmann procedure; abdominoper- ineal resection and anterior resection of the rectum for the treat- ment of different entities, such as diverticular disease, ulcerative colitis, familial adenomatous polyposis and rectal infiltration from ovarian cancer and rectal cancer. 5,6 Perineal abdominal re- section and preoperative radiotherapy are risk factors that signifi- cantly increase the incidence of presacral venous bleeding during rectal resection, with incidences reaching 9.2 and 10.6%, respec- tively, in some series. 3,4 Numerous different procedures have been reported to treat this complication, including packing techniques, tacking techniques, topical haemostatic agents and direct or indirect electrocoagulation and sutures. 7 The aim of this work is to present our experience in controlling presacral venous bleeding during rectal resection using indirect electrocoagulation via a fragment of the anterior rectus muscle of the abdomen. Methods This study is a retrospective observational study of six patients who were administered the indirect electrocoagulation technique via a fragment of the anterior rectus muscle of the abdomen to control presacral venous bleeding during rectal mobilization. Patients included four males and two females with an average age of 67 (range: 58–79) years who underwent rectal resection between January 2002 and December 2015. Of these patients, five patients were diagnosed with rectal cancer, resulting in an incidence of 0.57%. Perineal abdominal resection was performed in three patients, and lower anterior resection was performed in two patients. In one patient, the Hartmann procedure was performed for rectal metastasis from gastric cancer. Surgical technique Digital pressure was applied to control bleeding. The patient was placed in the supine position. An approximately 2 × 2 cm frag- ment of the anterior rectus muscle of the abdomen was resected. After removing the finger, pressure was applied to the bleeding area, with the muscle fragment mounted on dissecting forceps. © 2016 Royal Australasian College of Surgeons ANZ J Surg (2016) ANZJSurg.com