Diseases of the Colon & Rectum

, Volume 38, Issue 3, pp 276–280 | Cite as

Effect of omental pedicle hammock in protection against radiation-induced enteropathy in patients with rectal cancer

  • Hong Jo Choi
  • Hyung Sik Lee
Original Contributions


PURPOSE: The aim of this nonrandomized study was to assess effects against radiation-induced enteropathy by constructing an omental pedicle hammock, thus isolating the small bowel outside the pelvis. METHODS: Since 1991, 32 patients received the omental pedicle hammock procedure as an adjunct to definitive cancer surgery, and the perioperative experiences and toxic effects of radiation therapy were evaluated and compared with 25 patients who received pelvic floor reperitonealization only. RESULTS: There were no surgical complications related to the omental hammock procedure. Contrary to control cases that showed the bowel to adhere deeply in the pelvis, exclusion of the small bowel from the pelvic cavity demonstrated by contrast study was successful in all except four cases of a segment of bowel loop descent within the radiation portals. According to acute and late radiation morbidity scoring criteria, 26 patients (81 percent) scored Grade 0 in the treatment group, whereas only 3 patients (12 percent) scored Grade 0 in the control group (P<0.01) in the acute phase, and 28 patients (88 percent) of Grade 0 in the former group and 15 (60 percent) in the latter (P<0.025) in late phase. There has been no case of radiation-induced enteropathy requiring surgical treatment. CONCLUSION: The technique of bowel exclusion by pedicle omental hammock would make it possible to use higher doses of postoperative pelvic radiation therapy without fear of complications from radiation-induced enteropathy.

Key words

Rectal cancer Radiation therapy Omental pedicle hammock Radiation-induced enteropathy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 1985;312:1465–72.Google Scholar
  2. 2.
    Balslev IB, Pederson M, Teglbjaerg PS,et al. Postoperative radiotherapy in Dukes' B and C carcinoma of the rectum and rectosigmoid: a randomized multicenter study. Cancer 1986;58:22–8.PubMedGoogle Scholar
  3. 3.
    Dasmahapatra KS, Swaminathan AP. The use of a biodegradable mesh to prevent radiation associated small bowel injury. Arch Surg 1991;126:336–9.Google Scholar
  4. 4.
    Kinsella TJ, Bloomer WD. Tolerance of the intestine to radiation therapy. Surg Gynecol Obstet 1980;151:273–84.PubMedGoogle Scholar
  5. 5.
    Galland RB, Spencer J. The natural history of clinically established radiation enteritis. Lancet 1985;1:1257–8.PubMedGoogle Scholar
  6. 6.
    Perez CA, Brady LW. Overview. In: Perez CA, Brady LW, eds. Principles and practice of radiation oncology, 2nd ed. Philadelphia: JB Lippincott, 1992:51–5.Google Scholar
  7. 7.
    Russ JE, Smoron GL, Gagnon JD. Omental transposition flap in colorectal carcinoma: adjunctive use in prevention and treatment of radiation complications. Int J Radiat Oncol Biol Phys 1984;10:55–62.Google Scholar
  8. 8.
    DeLuca FR, Ragins H. Construction of an omental envelope as a method of excluding the small intestine from the field of postoperative irradiation to the pelvis. Surg Gynecol Obstet 1985;160:365–6.PubMedGoogle Scholar
  9. 9.
    Granai CO, Gajewski W, Madoc-Jones H, Moukhtar M. Use of the omental J flap for better delivery of radiotherapy to the pelvis. Surg Gynecol Obstet 1990;171:71–2.PubMedGoogle Scholar
  10. 10.
    Valle G, Ferrarie G. Use of omentum to contain the intestine in pelvic exenteration. Surg Gynecol Obstet 1969;33:772–5.Google Scholar
  11. 11.
    Devereux DF, Chandler JJ, Eisenstat T, Zinkin L. Efficacy of an absorbable mesh in keeping the small bowel out of the human pelvis following surgery. Dis Colon Rectum 1988;31:17–21.PubMedGoogle Scholar
  12. 12.
    Thom A, Baumann J, Chandler JJ, Devereux DF. Experience with high-dose radiation therapy and the intestinal sling procedure in patients with rectal carcinoma. Cancer 1992;70:581–4.PubMedGoogle Scholar
  13. 13.
    Kavanah MT, Feldman MI, Devereux DF, Kondi ES. New surgical approach to minimize radiation associated small bowel injury in patients with pelvic malignancies requiring surgery and high dose irradiation: a preliminary report. Cancer 1985;56:1300–4.PubMedGoogle Scholar
  14. 14.
    Devereux DF, Kavanah MT, Feldman MI,et al. Small bowel exclusion from the pelvis by a polyglycolic acid mesh sling. J Surg Oncol 1984;26:107–12.PubMedGoogle Scholar
  15. 15.
    Devereux DF, Eisenstat T, Zinkin L. The safe and effective use of postoperative radiation therapy in modified Astler Coller stage C3 rectal cancer. Cancer 1989;163:2393–6.Google Scholar
  16. 16.
    Dische S, Dowdell JW. A method to reduce radiation injury to intestine: a preliminary report. Radiother Oncol 1984;1:277–9.PubMedGoogle Scholar
  17. 17.
    Sugarbaker PH. Intrapelvic prosthesis to prevent injury of the small intestine with high dosage pelvic irradiation. Surg Gynecol Obstet 1983;157:269–71.PubMedGoogle Scholar
  18. 18.
    Durig M, Steenblock U, Herberer M, Harder F. Prevention of radiation injuries to the small intestine. Surg Gynecol Obstet 1984;159:162–3.PubMedGoogle Scholar
  19. 19.
    Green N, Iba G, Smith WR. Measures to minimize small intestine injury in the irradiated pelvis. Cancer 1975;35:1633–40.PubMedGoogle Scholar
  20. 20.
    Dobrowsky W, Schmid AP. Radiotherapy of presacral recurrence following radical surgery for rectal carcinoma. Dis Colon Rectum 1985;28:917–9.PubMedGoogle Scholar
  21. 21.
    Stearns MW Jr. Diagnosis and management of recurrent pelvic malignancy following combined abdominoperineal resection. Dis Colon Rectum 1980;23:359–61.PubMedGoogle Scholar
  22. 22.
    Overgaard M, Overgaard J, Sella A. Dose dependent relationship for radiation therapy of recurrent, residual, and primarily inoperable colorectal cancer. Radiother Oncol 1984;1:217–23.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1995

Authors and Affiliations

  • Hong Jo Choi
    • 1
  • Hyung Sik Lee
    • 2
  1. 1.Department of SurgeryDong-A University, College of MedicinePusanSouth Korea
  2. 2.Department of Radiation OncologyDong-A University College of MedicinePusanSouth Korea

Personalised recommendations