title: Feasibility and morbidity of using saline filled tissue expanders to reduce radiation-induced bowel injury in patients with gynecologic malignancies.
abstract: OBJECTIVE
  To evaluate the feasibility and morbidity of using saline filled tissue expanders (TE) to displace the small bowel during radiation therapy in patients with gynecologic malignancies.
  
  
  METHODS
  Ten patients undergoing surgical exploration for a gynecologic malignancy and deemed to be at high risk for the late effects of radiation therapy were consented for the possible placement of a TE. Indication for placement was need for post-operative radiation. Small bowel exclusion was reported in terms of the lowest loop identified on treatment planning film using orally ingested barium.
  
  
  RESULTS
  Small bowel loops were excluded from the pelvis to varying degrees in all patients. Lowest identifiable bowel was marked at the L4-L5 interspace in one patient, L5-S1 interspace in three patients, at or near the sacral promontory in three patients, and to the middle of S2 in one patient. In two patients the TE was removed prior to simulation. Early complications included migration of the TE during treatment, development of a vesicovaginal fistula requiring immediate removal of the TE, and enterocutaneous fistula formation in a patient who developed an abscess following treatment completion. Another patient experienced a rectovaginal fistula 18 months after removal of the TE.
  
  
  CONCLUSIONS
  TE placement can successfully isolate small bowel from the pelvis. Usage should be individualized to minimize the likelihood of short and long-term complications, particularly in patients at higher risk of morbidity.
authors.affiliation: Division of Gynecologic Oncology, University of Minnesota, Department of Obstetrics, Gynecology and Women's Health, Minneapolis, MN 55455, USA. gelle005@umn.edu
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Geller
authors.forename: Peter A
authors.initials: PA
authors.lastname: Argenta
authors.forename: Sajeena G
authors.initials: SG
authors.lastname: Thomas
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Dusenbery
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Judson
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Boente
mesh_terms: D000328:Adult; D000368:Aged; D004307:Dose-Response Relationship, Radiation; D016889:Endometrial Neoplasms / Q000532:radiotherapy / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007421:Intestine, Small / Q000293:injuries* / Q000528:radiation effects*; D008875:Middle Aged; D011832:Radiation Injuries / Q000517:prevention & control*; D011878:Radiotherapy / Q000009:adverse effects*; D012965:Sodium Chloride; D015625:Tissue Expansion Devices / Q000009:adverse effects; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy / Q000601:surgery
chemical_list: D012965:Sodium Chloride