Ileal loop in the treatment of radiation-treated pelvic malignancies: a comparative review.

Critical analysis of ureteroileal diversion in the treatment of pelvic tumors in which prior radiation therapy was administered has prompted us to review our experience with ileal loops after patients have been irradiated. Between 1970 and 1975, 136 adults underwent ureteroileal bypass. Of these patients 36 had preoperative irradiation for various pelvic malignancies, 44 had malignancies but no irradiation and 56 were operated upon for neurogenic bladders. Major morbidity in the irradiated group included wound infections (33 per cent), ureteroileal urinary leaks (19.4 per cent) and paralytic ileus (13.9 per cent). The average postoperative hospital stay for this group was 8 to 11 days longer than that of the other 2 groups. In contrast, however, the overall incidence of reoperations for various complications in the irradiated group was only 11 per cent, compared to 25 per cent in the group not given preoperative radiation and 30.4 per cent of those operated upon for neurogenic bladders. Most significantly, none of the patients in the irradiated group required re-exploration and surgical correction of ureteroileal urinary fistulae. Comparison of these results to those reported in the literature is favorable. The ileal loop remains a simple and viable operative technique in patients requiring urinary diversion for pelvic malignancies previously irradiated.