Correlation between radiotherapy and suture fistulas following colo-anal anastomosis for carcinoma of the rectum evaluation of 152 consecutive patients.
BACKGROUND
The aim of this study was to evaluate the prevalence of suture fistulas and their possible correlation with adjuvant therapy in patients who underwent colo-anal anastomosis and J pouch reconstruction with a protective colostomy. The reliability of the radiological screening and monitoring program was also verified.


METHODS
One hundred and fifty-two consecutive patients were evaluated radiologically with water-soluble radio-opaque contrast enema before surgery for closure of the protective colostomy. Fifty-seven patients were treated with surgery alone (group A) and 95 patients received adjuvant treatment (group B).


RESULTS
A total of 54 fistulas were seen: 17 in group A (28.9% of patients in group A) and 37 in group B (38.9% of patients in group B). Six fistulas involved the rectovaginal septum. All fistulas were managed medically. The time to resolution was 30 days in 76.4% of patients in group A and about 50 days in 82% of patients in group B. Rectovaginal fistulas always took much longer to heal in both groups and failed to heal in two of the four cases in group B.


CONCLUSIONS
Two factors appear to contribute to the high prevalence of fistulas in this series: extension of radiological screening to all operated patients and adjuvant radiotherapy. However, the postoperative course was not compromised by radiotherapy in that these fistulas resolved with medical treatment alone, although healing took longer. The incidence of rectovaginal fistulas was substantially the same in the two groups, but two of the four occurring in group B did not heal. Postoperative monitoring with water-soluble contrast enema appears to be the diagnostic procedure of choice because it is well tolerated, non-invasive and a reliable aid in planning surgical bowel recanalization since no false negative cases were detected clinically after closure of the colostomy.
Civelli
Enrico Maria
EM
Department of Radiology, National Institute Research, Milan, Italy. rdc@istitutotumori.mi.it
Gallino
Gianfrancesco
G
Valvo
Francesca
F
Cozzi
Guido
G
Belli
Filiberto
F
Bonfanti
Giuliano
G
Folini
Cristina
C
Suman
Laura
L
Meroni
Roberta
R
Vercelli
Ruggero
R
Leo
Ermanno
E
Severini
Aldo
A
D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003106:Colon / Q000601:surgery*; D003125:Colostomy; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D008297:Male; D015995:Prevalence; D011859:Radiography; D012004:Rectal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D013536:Suture Techniques / Q000009:adverse effects*