Abdominopelvic omentopexy: preparatory procedure for radiotherapy in rectal cancer

Adjuvant radiotherapy (RT) in adenocarcinoma of the rectum requires the application of between 5,500 and 6,600 cGy, while the small bowel does not tolerate doses beyond 4,200 cGy without developing enteritis, often followed by stenosis, fistulas, or perforation. This has spurred several attempts to form an artificial diaphragm between the abdominal cavity and the true pelvis, but they were all burdened with various sequelae. Thus, we developed a simple technique to retain the small bowel out of the RT target volume. From the greater omentum we form a bag, which houses the intestinal loops. The lower margin of the omentum is attached to the parietal peritoneum of the posterior abdominal wall beyond the promontorium. The lateral edges are sutured to the ascending and descending colon. RT starts immediately after the laparotomy wound has healed. With the help of this abdominopelvic omentopexy, we have performed high-dose RT following tumor resection in 43 patients. RT was free of complications in all of them as far as the small bowel is concerned. Proctitis and/or cystitis occurred in 14 patients.