Introduction: Small intestinal fibrosis induced by chronic radiation enteritis (CRE) is a major complication following radiotherapy and an important underlying disease of short bowel syndrome. This study is to investigate the effect of modified surgical strategy on preventing both major small bowel resection followed by late-term short bowel syndrome and short-term postoperative anastomotic leakage. Methods: We divide all CRE patients with pelvic radiation enteritis-induced intestinal stenosis (REIIS) and intestinal obstruction macroscopically into two subtypes:

Type I. Terminal ileum lesion with or without proximal intestine injury (figure 1);

Type II. Isolated intestinal lesion. Records of all 22 type I patients from Apr. 2017 to Dec. 2018 were analyzed. All the patients underwent minimal resection of small intestinal lesion with primary anastomosis between ileum segments and protective proximal loop enterotomy (figure 2). Postoperatively, stoma effluents were recycled through distal loop where the anastomosis were located. Intraoperative information and postoperative complications were retrospectively analyzed, including patients’ general information, intraoperative bleeding volume, length of resected small bowel, adhesion grade, postoperative complication, postoperative hospital stay, postoperative recovery to total enteral nutrition and recycling time of stoma effluents.

Results: All the operations were performed. Length of resected small bowel was 25-100cm. No severe complications like anastomotic leakage were observed postoperatively. All the patients recovered to total enteral nutrition in 5-14 days and began ileostomy recycling in 5-14 days. Postoperative stay was 9-23 days. During a follow-up of 1-21 months, one patient died of cancer recurrence and all the other patients kept well nourished.

Conclusion: Protective proximal loop enterotomy is feasible for the surgery of radiation enteritis presenting with terminal small bowel fibrosis. This strategy can both prevent severe postoperative complications and reduce extensive intestinal resection and thus improve both peri-operative recovery and long-term outcome.