Efficacy of an absorbable mesh in keeping the small bowel out of the human pelvis following surgery

Patients with pelvic malignancies frequently require postoperative radiation therapy either as adjunctive or palliative treatment. Tumoricidal doses, however, are frequently associated with small-bowel damage. Animal experiments demonstrated tolerance to high-dose radiation therapy and protection from radiation enteritis by use of an absorbable polymer polyglycolic acid (PGA) that is used as an intestinal sling to elevate the small bowel away from the operated site. Sixty patients (42 with rectal carcinomas and 18 with gynecologic malignancies) underwent surgical treatment that included the intestinal sling procedure. Postoperative radiation was begun within three weeks following surgery and patients received a mean approximating 5500 rads in fractionated doses. A mean follow-up time of 28 months has not revealed a single case of radiation enteritis (by either contrast studies or physiologic studies) or PGA mesh-related complications. The authors believe that this surgical technique should be employed in patients who may require postoperative radiation treatment for pelvic malignancy.