Protection of the Small Intestine against Irradiation by Means of a Removable Adapted Prosthesis: A Preliminary Study

Abstract

A prosthesis was designed to protect the intestinal loop from external beam radiation therapy, when postoperative radiation is indicated. It is a silicone-made inflatable balloon, the implantation of which permits to drive the intestinal loops out of the irradiation field, and which is easy to remove after radiation therapy. The device has been used in 7 patients, 4 patients with a retroperitoneal soft tissue sarcoma and 3 patients with recurrent pelvic tumor. After surgical resection of the tumor the device is placed either in the retroperitoneal space or in the pelvic cavity. A polyglactine 910 mesh is placed between the spacer and the bowel to prevent loop incarceration. The prosthesis can be emptied between each radiation course and then removed through a 3-cm incision under local or locoregional anesthesia. The tolerance of the small intestine of the radiation therapy has been satisfactory in each case with no bowel injury due to radiation. Therefore, this simple device might be useful in order to prevent bowel injury during postoperative radiation in the treatment of abdominal and retroperitoneal tumor masses when indicated.

Radiation-induced small bowel disease: latest developments and clinical guidance

“…Repeat surgery may be necessary to remove the prosthesis after completion of the radiation therapy, although inflatable saline implants have been developed to reduce this problem [Sezeur et al 1990]. …”

Pelvic silicone prosthesis for prevention of radiation enteritis: US and CT features

“…The objective is to keep small bowel loops away from the radiation portals and from filling in the space previously occupied by the resected neoplasm [1][2][3][4][5][6]. Nonoperative procedures include patient positioning, customized abdominal molds, external compression devices, selective radiation fields, and urinary bladder distention during irradiation sessions [2].…”

“…In addition, repeat surgery may be necessary to remove the prosthesis after completion of the radiation therapy. An inflatable saline implant requires a less invasive procedure for its retrieval [6].…”

Prevention of complications following pelvic exenteration with the use of mammary implants in the pelvic cavity: Technique and results of 28 cases

“…Other authors implement other procedures such as the positioning of an omental sling, polypropelene prosthetics, skin expanders and goretex prosthetics [7,8]. In these patients, in addition to a radical treatment of the tumor, the surgeon must prevent complications-such as radiation lesions, enteric fistulas from inflammatory phenomena or from recurrence and occlusions from internal hernias-that may result from the occupation of the pelvic cavity by the intestinal mass.…”

“…In the latter 20 cases we used anatomical shaped mammary implants, which, rotated by 1808, adapt perfectly to the confirmation of the pelvis of both female and male patients (Figs. [6][7][8]. Before positioning the implants, two crossover Black Drain 1 type drains are placed in the pelvis.…”