Radiation proctitis surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
Surgery is not the first-line treatment option for patients with radiation proctitis | Surgery is not the first-line treatment option for patients with radiation proctitis as it can lead to severe post-operative complications which include: | ||
* Significant bleeding | |||
* Sepsis | |||
* Inadvertent enterotomies | |||
* Formation of fistula | |||
* Short bowel syndrome due to extensive bowel resection | |||
* Creation of blind loops due to excessively long bypassed segments | |||
* Nonhealing of anastomoses performed on irradiated tissue | |||
* Anastomotic leak with peritonitis sepsis | |||
However it is usually reserved as a last resort for patients with:<ref name="pmid1914719">{{cite journal| author=Lucarotti ME, Mountford RA, Bartolo DC| title=Surgical management of intestinal radiation injury. | journal=Dis Colon Rectum | year= 1991 | volume= 34 | issue= 10 | pages= 865-9 | pmid=1914719 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1914719 }}</ref><ref name="pmid25687266">{{cite journal| author=Wu XR, Liu XL, Katz S, Shen B| title=Pathogenesis, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis. | journal=Inflamm Bowel Dis | year= 2015 | volume= 21 | issue= 3 | pages= 703-15 | pmid=25687266 | doi=10.1097/MIB.0000000000000227 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25687266 }}</ref> | |||
* Hx of unresponsiveness to medical or endoscopic treatment | * Hx of unresponsiveness to medical or endoscopic treatment | ||
* Hx of intractable symptoms/complications like stricture, pain, bleeding, perforation, or a fistula. | * Hx of intractable symptoms/complications like stricture, pain, bleeding, perforation, or a fistula. | ||
Surgical options for radiation proctitis include: | |||
* excision | |||
* urinary and fecal diversion (diverting stoma) and | |||
* reconstruction of a coloanal J reservoir | |||
==References== | ==References== | ||
Revision as of 04:29, 11 June 2019
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Overview
Surgery
Surgery is not the first-line treatment option for patients with radiation proctitis as it can lead to severe post-operative complications which include:
- Significant bleeding
- Sepsis
- Inadvertent enterotomies
- Formation of fistula
- Short bowel syndrome due to extensive bowel resection
- Creation of blind loops due to excessively long bypassed segments
- Nonhealing of anastomoses performed on irradiated tissue
- Anastomotic leak with peritonitis sepsis
However it is usually reserved as a last resort for patients with:[1][2]
- Hx of unresponsiveness to medical or endoscopic treatment
- Hx of intractable symptoms/complications like stricture, pain, bleeding, perforation, or a fistula.
Surgical options for radiation proctitis include:
- excision
- urinary and fecal diversion (diverting stoma) and
- reconstruction of a coloanal J reservoir
References
- ↑ Lucarotti ME, Mountford RA, Bartolo DC (1991). "Surgical management of intestinal radiation injury". Dis Colon Rectum. 34 (10): 865–9. PMID 1914719.
- ↑ Wu XR, Liu XL, Katz S, Shen B (2015). "Pathogenesis, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis". Inflamm Bowel Dis. 21 (3): 703–15. doi:10.1097/MIB.0000000000000227. PMID 25687266.