Parks' coloanal pull-through anastomosis for severe, complicated radiation proctitis

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Abstract
Various operations were proposed for the treatment of radiation injuries of the rectum. Resectioning of the diseased segment down to its points of fixation to the vagina, bladder or prostate, with perianal mucosal stripping of the anorectal segment and primary coloanal (pull-through) anastomosis, was performed in 11 patients. In 2 others, an attempt at colorectal anastomosis was abandoned because of extreme scarring in the pelvis. The procedures were done following definitive treatment of rectal carcinoma (7 patients), cervical carcinoma (2 patients), carcinoma of the uterus (1 patient), carcinoma of the ovary (1 patient), seminoma (1 patient) and carcinoma of the bladder (1 patient). One patient died from a pulmonary embolus on the 7th postoperative day. Of the survivors with a coloanal anastomosis, all had successful closure of their temporary colostomies with follow-up from 1-6 yr. In 8, continence was assessed as being good or excellent. Four patients required anastomotic dilatation; another required a surgical procedure for anastomotic stricture. There was 1 instance each of reoperation for small bowel obstruction and ileocolic fistula. There were no instances of recurrence of hemorrhage, fistulas, perineal pain or tenesmus. This procedure obviates the need for a difficult dissection of the lower rectum and separation of tissues damaged by radiation and avoids the need for eversion techniques. Its selective use is advocated for patients suffering from severe radiation injuries of the rectum.

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