The radiation‐damaged rectum: Resection with coloanal anastomosis using the endoanal technique

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Abstract
Fifty‐nine consecutive patients with a radiation‐damaged rectum were treated by subtotal rectal resection, continuity being restored by coloanal sleeve anastomosis using the endoanal suture technique. There were no deaths. Technical success was achievd in 55 patients (93%) with rectovaginal fistula, hemorrhagic proctitis, painful radiation ulcer, rectal stricture, or carcinoma developing in an irradiated rectum. An additional risk factor was present in all 4 technical failures, including a divided irradiated sphincter, previously divided marginal artery, diabetes, and persistent sepsis. Restorative surgery was attempted in all patients, irrespective of the severity of the radiation injury. Postoperative continence depended on anal sphincter function, with an improvement in full continence from 54% to 76% over the first postoperative year. Of the first 28 patients assessed at 1 year after operation, all 19 of those whose initial condition was well above the sphincter mechanism were fully continent, compared to only 2 of 9 with low fistulas extending down to the anal sphincter, which in these patients was histologically shown to be severely damaged by radiation. The functional status was assessed 1 year after surgery in 46 of the total 59 unselected patients treated. Thirty‐five were continent (76%), 7 incompletely continent (15%), and 4 incontinent (9%). Long‐term follow‐up was possible in 35 of the first 37 consecutive patients successfully treated before February, 1980, and followed for a mean of 5.1 years (range 1–8 years 9 months). Four died of recurrent cancer. Twenty‐four (77%) of the surviving 31 patients were fully continent at the time of final assessment, 4 incompletely continent, and 3 (9.7%) reverted to a colostomy because of incontinence or pelvic obstruction.