Colonic J pouch reconstruction of the radiation-damaged neorectum.
BACKGROUND
Postoperative radiotherapy after restorative resection for rectal carcinoma can cause fibrosis, stricture and proctitis. There are few accounts in the literature of the surgical approach to the radiation-damaged neorectum.


METHODS
Reported are four patients who underwent resection of the radiation-damaged neorectum with colonic J pouch reconstruction between September 1996 and July 1997. The operative and postoperative course is described. Parameters of bowel function were assessed by standardized interview 6 months after ileostomy reversal. Ongoing follow up has occurred to the present time.


RESULTS
There was no mortality. Complications were splenic injury requiring splenectomy and a pelvic collection requiring percutaneous drainage. At 6 months after ileostomy reversal all patients had ongoing disturbance of bowel function, and two patients described some degree of incontinence. The mean frequency of bowel actions was four per day. Two patients have subsequently undergone further resection and formation of an end stoma.


CONCLUSIONS
Resection of the radiation-damaged neorectum with colonic J pouch reconstruction is technically feasible. Functional results in the present series were disappointing and half the patients went on to formation of a permanent stoma.
Thompson
A N
AN
Colorectal Surgical Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. athompson@optusnet.com.au
Levitt
M
M
D000328:Adult; D000368:Aged; D003672:Defecation; D004322:Drainage; D005240:Feasibility Studies; D005242:Fecal Incontinence / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D018579:Patient Selection; D011349:Proctitis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D011855:Radiodermatitis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D013154:Spleen / Q000293:injuries / Q000601:surgery; D013156:Splenectomy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome