Resection and mucosal proctectomy with coloanal anastomosis for radiation-damaged rectum

Later radiation injuries occur in 2% to 17% of patients receiving pelvic irradiation, with the rectum the most commonly injured part of the gut. Proctitis, ulceration, stricture and fistula formation are among the most common injuries. If symptoms can not be resolved by medical management, surgery may be helpful. Indications for surgery include rectal fistulas, persistent proctitis, rectal strictures and malignant tumor in the rectum. The current study reviewed 15 patients who underwent resection, mucosal proctectomy and coloanal anastomosis at Chang Gung Memorial Hospital between 1984-1993. There were 10 patients with rectal fistula, 3 with rectal stricture, 1 with severe rectal bleeding with anemia, and 1 with radiation proctitis and rectal cancer. There was no perioperative mortality. Success rate for gastrointestinal continuity was 53%. Among eight patients with successful restoration of continuity, six received two-stage operations and two, three-stage. The remaining seven patients (47%) still required a diverting colostomy because of recurrent fistula or stenotic anastomosis. Although diversion is a safer and quicker procedure, a rectosigmoidectomy plus mucosal proctectomy with coloanal sleeve anastomosis provides a fair opportunity for restoration of intestinal continuity.