Sphincter-saving Procedure for Radiation-injured Rectum

A Report of Four Cases with Special Reference to Pull-through Procedure

Abstract

Up to this time the sigmoid colostomy has been widely accepted and conventional treatment for radiation-injured rectum, but patients without residual malignancy strongly desire to live without colostomy. We have tried to remove the involved rectal segments by sphincter-saving procedures. Four patients underwent these procedures, pull-through procedure in three and low anterior resection in one. Among sphincter-saving procedures, pull-through procedure was most adequate.
Provided the following five conditions are fulfilled, pull-through procedure should be considered for severe radiation-injured rectum.
(1)No recurrence of initial malignancy in the pelvis.
(2) More than 2 cm intact rectal segment above dentate line may be preserved.
(3) No radiation-injured segment in upper sigmoid.
(4) No severe radiation damage in small intestine.
(5) Patients under 70 year-old, with normal tonus of anal sphincter.