Effect of omental pedicle hammock in protection against radiation-induced enteropathy in patients with rectal cancer.

PURPOSE: The aim of this nonrandomized study was to assess effects against radiation-induced enteropathy by constructing an omental pedicle hammock, thus isolating the small bowel outside the pelvis.

METHODS

Since 1991, 32 patients received the omental pedicle hammock procedure as an adjunct to definitive cancer surgery, and the perioperative experiences and toxic effects of radiation therapy were evaluated and compared with 25 patients who received pelvic floor reperitonealization only.

RESULTS

There were no surgical complications related to the omental hammock procedure. Contrary to control cases that showed the bowel to adhere deeply in the pelvis, exclusion of the small bowel from the pelvic cavity demonstrated by contrast study was successful in all except four cases of a segment of bowel loop descent within the radiation portals. According to acute and late radiation morbidity scoring criteria, 26 patients (81 percent) scored Grade 0 in the treatment group, whereas only 3 patients (12 percent) scored Grade 0 in the control group (P < 0.01) in the acute phase, and 28 patients (88 percent) of Grade 0 in the former group and 15 (60 percent) in the latter (P < 0.025) in late phase. There has been no case of radiation-induced enteropathy requiring surgical treatment.

CONCLUSION

The technique of bowel exclusion by pedicle omental hammock would make it possible to use higher doses of postoperative pelvic radiation therapy without fear of complications from radiation-induced enteropathy.