Reconstructive surgery for the complications of pelvic irradiation

Abstract

Severe damage to the pelvic viscera is a complication of irradiation therapy [for gynecologic cancer] that, unfortunately, cannot always be avoided. Resulting rectal and rectocolonic strictures, rectovaginal fistulas, and shortening and stenosis of the vagina present very difficult problems that frequently require a colostomy for relief and may permanently impair sexual function. A new approach is presented to correct these lesions based on the use of proximal nonirradiated colon which serves as a vascular pedicle graft to correct the defect without a complicated and massive resection. Twenty-two such operations have been done with 19 satisfactory to excellent results and 2 total failures (1 death from small bowel complications). All patterns and combinations of irradiation injury were found amenable to this technique of repair. These have included both web and linear strictures with and without fistulas. In 1/2 of the patients, it was possible to make use of normal colon bypassed by a prior colostomy. Normal nonirradiated colon with good blood supply will heal satisfactorily to irradiated colon or rectum, thus making excision of all the irradiated tissue unnecssary. The results of this surgical approach have thus far been gratifying and warrant further trials for these injuries.