Ym. Vankasteren et al., EFFICACY OF A SYNTHETIC MESH SLING IN KEEPING THE SMALL-BOWEL IN THE UPPER ABDOMEN TO PREVENT RADIATION ENTEROPATHY IN GYNECOLOGIC MALIGNANCIES, European journal of obstetrics, gynecology, and reproductive biology, 50(3), 1993, pp. 211-218
Radiation therapy in gynecological malignancies is limited by the freq
uent occurrence of radiation enteropathy at effective dose levels of 4
5 Gy and higher. Elevation of the small bowel out of the true pelvis s
hould enable doses of up to 60-70 Gy to be given without damaging the
small bowel. We report a feasibility study concerning elevation of the
small bowel out of the true pelvis, by creating an intra-abdominal sl
ing with a synthetic mesh. Twelve patients with pelvic gynecological m
alignancies were included since 1986. In all patients peroperative app
lication of the mesh was possible. In ten patients adequate elevation
of the small bowel was achieved. Two patients showed a right-sided her
niation of a small bowel loop on a control barium opacification, perfo
rmed 1 week postoperatively. In one of these a fistula occurred after
resecuring the mesh. The most important problem in this study, as has
also been reported elsewhere, was a herniation of a small bowel loop.
The incidence is probably inversely correlated with the skill of the s
urgeon and will therefore be reduced with increasing experience. Futur
e long-term studies should address the issue whether or not radiation
enteropathy can be prevented by this method.