USE OF SALINE-FILLED TISSUE EXPANDERS TO PROTECT THE SMALL-BOWEL FROMRADIATION

Over the past 7 years, 58 Saline-filled tissues expanders (TEs) have b een temporarily placed in 57 patients. The indications for TE placemen t were: small bowel exclusion from external-beam radiation therapy (N = 25), interstitial RT (N = 16), or both (N = 13) when there was insuf ficient omentum to provide adequate exclusion. Of the 57 patients, 24 had primary turners (4 colon, 4 endometrial, and 11 rectal cancers; 3 sarcomas, 1 schwannoma; and 1 vaginal cancer). The remaining 33 patien ts (58%) had recurrent cancers (3 anal, 8 colon, and 16 rectal cancers ; and 6 sarcomas), of whom 26 (79%) had received prior RT Of the 58 TE s, 15 were placed superior to the iliac vessels and 43 were placed in the pelvis, Complications included post-withdrawal enterocutaneous fis tulae in four patients, TE deflation in three patients, and TE extrusi on in one patient. Improvements in TE design and removal techniques ha ve reduced the incidence of these complications. When no native tissue is available for small bowel exclusion, the saline-filled TE is a saf e, effective substitute.