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Late radiogenic small bowel damage: guidelines for the general surgeon
1Department of General Surgery, District Hospital, Tamsweg, Austria.
Digestive Surgery
|August 7, 1999
Summary
Late radiogenic small bowel injuries often present with obstruction. Safer surgical management guidelines for general surgeons are provided, emphasizing ileotransversostomy for resection and bypass, and avoiding lysis in injured bowel segments.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Radiation Oncology
Background:
- Late radiogenic small bowel injuries frequently manifest as obstruction or peritonitis years after radiotherapy.
- General surgeons often manage these complex cases with limited prior experience due to the long latency period.
Purpose of the Study:
- To provide general surgeons with comprehensive guidelines for safer surgical management of late radiogenic small bowel injuries.
- To improve outcomes for patients experiencing complications from radiation therapy to the small intestine.
Main Methods:
- A systematic review of 41 publications was conducted.
- Clinical, procedural, and outcome data were analyzed from the selected literature.
Main Results:
- Small bowel radiation injury presents a mean of 3.4 years post-radiotherapy, primarily as obstruction (71%), with frequent involvement of the lower ileum, cecum, and rectosigmoid.
- Resection with ileotransversostomy shows a 4% dehiscence rate, while bypass with ileotransverse anastomosis has a 1.6% dehiscence rate and 37% progressive radiation injury rate.
- Suture line insufficiency is highly lethal (85%), and lysis of injured bowel carries a 6% perforation risk; overall 2-year survival is 58%.
Conclusions:
- Ileal resection with right hemicolectomy and ileotransversostomy is a safe option for resection.
- Ileotransverse anastomosis is the preferred bypass method; lysis should be avoided in radiation-injured bowel.
- Terminal enterostomy with mucous fistula can manage untreatable fistulae effectively.