Combined abdominotranssacral reconstruction of the radiation-injured rectum.

Reconstruction of the rectum by a technic of combined abdominotranssacral proctocolectomy and proctocolostomy is presented as an alternative to the surgical conservatism that has been the time-honored approach to the management of radiation-injured rectum. The procedure has permitted safe accomplishment of rectal anastomosis with as little as a 1 cm distal rectal stump. Satisfactory, true anal sphincteric continence is enjoyed by six patients who have been completely reconstituted, and satisfactory reconstitution in the remaining two is anticipated. These results suggest that reinspection of the traditional approach to the radiation-injured rectum is warranted now that safe and physiologically effective reconstitution can be accomplished by a combined abdominotranssacral technic.