The use of a biodegradable mesh to prevent radiation-associated small-bowel injury
K. S. Dasmahapatra and A. P. Swaminathan
Comprehensive Surgical Associates, Perth Amboy, NJ.
Radiation-associated small bowel injury occurs in up to 50% of patients
receiving postoperative radiotherapy following pelvic cancer surgery. We
describe our experience using a biodegradable mesh that allows the small
bowel to be supported above the pelvic inlet and is totally absorbed
following radiation therapy. Between 1985 and 1989, 45 procedures were
performed in patients with carcinoma of the rectum (anterior resection in
15 patients, abdominoperineal resection in 23 patients, pelvic exenteration
in six patients, and proctocolectomy in one patient). In 30 patients a
polyglycolic acid (Dexon) mesh was used, and in 15 patients a polyglactin
910 (Vicryl) mesh was used. Forty-four patients received postoperative
radiotherapy. The mean (+/- SEM) dose was 56.8 +/- 18.4 Gy. There were no
immediate complications related to the mesh. Follow-up ranged from 12 to 53
months (median follow-up, 34 months). With the exception of two patients
who had a polyglactin 910 mesh and who developed bowel obstruction due to
adhesions under the anterior abdominal wall, there has been no documented
incidence of clinical radiation-associated small bowel injury. The use of
the absorbable mesh may permit us to use higher doses of postoperative
radiotherapy without the associated hazard of radiation-associated small
bowel injury.
