Diseases of the Colon & Rectum

, Volume 35, Issue 2, pp 151–157 | Cite as

Effect of intraoperative radiation on the tensile strength of small bowel anastomoses

  • Theodore J. Saclarides
  • David A. Rohrer
  • Achyut K. Bhattacharyya
  • Mahendra S. Bapna
Original Contributions


Increasing interest in the use of preoperative or intraoperative radiation therapy for cancer has led to concerns regarding tissue healing and integrity subsequent to treatment. This is especially so for intestinal anastomoses incorporating irradiated bowel, where poor healing may lead to anastomotic disruption and sepsis. One hundred thirty Sprague-Dawley rats were randomized into five groups as follows: both limbs, one limb, or neither limb of an anastomosis received 2,000 R of radiation intraoperatively. A fourth group had a segment of small bowel irradiated, with no anastomosis; a fifth group had the gut exposed by celiotomy. The control groups and all anastomoses underwent tensile strength measurements on the seventh postoperative day, with findings as follows: no anastomosis, no irradiation, 143.75 g; no anastomosis, irradiated, 114.50 g; anastomosis, no irradiation, 85.273 g; anastomosis, one limb irradiated, 78.100 g; anastomosis, both limbs irradiated, 59.00 g. There was no statistical difference in tensile strength of the anastomosis between when neither limb and when just one limb was irradiated. However, when both limbs were irradiated, the loss of strength was statistically significant (P=0.002). Irradiation damage scores were assigned using Blacket al.'s histologic scoring system. These scores were not significantly different between the irradiated segments. Inflammation and fibrosis scores for the anastomoses were also not significantly different. These results indicate that, in rats, anastomotic healing is impaired only when both limbs of the anastomosed intestine are irradiated. The normal strength of the anastomosis with only one limb irradiated cannot be explained by differences in inflammation, fibrosis, or radiation damage and is caused by an undetermined factor.

Key words

Intraoperative radiation Bowel anastomosis Tensile strength 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Eloesser L. The treatment of some abdominal cancers by irradiation through the abdomen combined with cautery excision. Ann Surg 1937;106:645–52.Google Scholar
  2. 2.
    Abe M, Takhashi M. Intraoperative radiotherapy: the Japanese experience. Int J Radiat Oncol Biol Phys 1981;7:863–8.PubMedGoogle Scholar
  3. 3.
    Abe M, Takahashi M, Yabumoto E,et al. Clinical experiences with intraoperative radiotherapy of locally advanced cancers. Cancer 1980;45:40–8.PubMedGoogle Scholar
  4. 4.
    Abe M, Takahashi M, Yabumoto E,et al. Techniques, indications and results of intraoperative radiotherapy of advanced cancers. Radiology 1975;116:693–702.PubMedGoogle Scholar
  5. 5.
    Abe M, Yabumoto E, Takahashi M,et al. Intraoperative radiotherapy of gastric cancer. Cancer 1974;34:2034–41.PubMedGoogle Scholar
  6. 6.
    Goldson AL, Ashaveri E, Espinoza MC,et al. Single high dose intraoperative electrons for advanced stage pancreatic cancer: Phase I pilot study. Int J Radiat Oncol Biol Phys 1981;7:869–74.PubMedGoogle Scholar
  7. 7.
    Gunderson L, Shipley W, Suite HD,et al. Intraoperative irradiation: a pilot study combining external beam photos with “boost” dose intraoperative electrons. Cancer 1982;49:2259–66.PubMedGoogle Scholar
  8. 8.
    Shipley WV, Wood WC, Tepper JE,et al. Intraoperative electron beam irradiation for patients with unresectable pancreatic carcinoma. Ann Surg 1984;200:289–94.PubMedGoogle Scholar
  9. 9.
    Sindelar WF, Hoestra H, Kinsella T. Surgical approaches and techniques in intraoperative radiotherapy for intra-abdominal, retroperitoneal, and pelvic neoplasms. Surgery 1988;103:247–56.PubMedGoogle Scholar
  10. 10.
    Sindelar WF, Tepper JE, Kinsella T,et al. Experimental and clinical studies with intraoperative radiotherapy. Surg Gynecol Obstet 1983;157:205–19.PubMedGoogle Scholar
  11. 11.
    Sindelar WF, Tepper JE, Travis EL,et al. Tolerance of retroperitoneal structures to intraoperative radiation. Ann Surg 1982;196:601–8.PubMedGoogle Scholar
  12. 12.
    Tepper JE, Cohen AM, Wood WC,et al. Intraoperative electron beam radiotherapy in the treatment of unresectable rectal cancer. Arch Surg 1986;12:421–3.Google Scholar
  13. 13.
    Tepper JE, Million R. Radiation therapy and surgery. Am J Clin Oncol 1988;11:381–6.PubMedGoogle Scholar
  14. 14.
    Tepper JE, Sindelar WF. Summary of the workshop on intraoperative radiation therapy. Cancer Treat Rep 1981;65:911–8.PubMedGoogle Scholar
  15. 15.
    Tepper JE, Sindelar WF, Travis EL,et al. Tolerance of canine anastomoses to intraoperative radiation therapy. Int J Radiat Oncol Biol Phys 1983;9:987–92.PubMedGoogle Scholar
  16. 16.
    Black WC, Gomez JF, Yuhas JM, Kligirman MM. Quantitation of the late effects of X-radiation on the large intestine. Cancer 1980;45:444.PubMedGoogle Scholar
  17. 17.
    Jensen MH, Sauer T, Devik F, Nygaard K. Late changes following single-dose roentgen irradiation of rat small intestine. Acta Radiol [Oncol] 1983;22:299–303.Google Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1992

Authors and Affiliations

  • Theodore J. Saclarides
    • 1
  • David A. Rohrer
    • 1
  • Achyut K. Bhattacharyya
    • 2
  • Mahendra S. Bapna
    • 3
  1. 1.Department of General SurgeryRush Medical CollegeUSA
  2. 2.Department of PathologyRush Medical CollegeUSA
  3. 3.Biomaterial SectionUniversity of Illinois College of DentistryChicago

Personalised recommendations