Colonic J pouch reconstruction of the radiation-damaged neorectum

Background: Postoperative radiotherapy after restorative resection for rect al carcinoma can cause fibrosis, stricture and proctitis. There are few acc ounts in the literature of the surgical approach to the radiation-damaged n eorectum. Methods: Reported are four patients who underwent resection of the radiatio n-damaged neorectum with colonic J pouch reconstruction between September 1 996 and July 1997. The operative and postoperative course is described. Par ameters of bowel function were assessed by standardized interview 6 months after ileostomy reversal. Ongoing follow up has occurred to the present tim e. Results: There was no mortality. Complications were splenic injury requirin g splenectomy and a pelvic collection requiring percutaneous drainage. At 6 months after ileostomy reversal all patients had ongoing disturbance of bo wel function, and two patients described some degree of incontinence. The m ean frequency of bowel actions was four per day. Two patients have subseque ntly undergone further resection and formation of an end stoma. Conclusions: Resection of the radiation-damaged neorectum with colonic J po uch reconstruction is technically feasible. Functional results in the prese nt series were disappointing and half the patients went on to formation of a permanent stoma.