Surgery is not the first-line treatment option for patients with radiation proctitis. However it is usually reserved as a last resort for patients with refractory symptoms and complications.

Surgery is not the first-line treatment option for patients with radiation proctitis as it can lead to severe post-operative complications which include:^[1]

• Significant bleeding
• Sepsis
• Inadvertent enterotomies
• Formation of fistula
• Short bowel syndrome due to extensive bowel resection
• Creation of blind loops due to excessively long bypassed segments
• Nonhealing of anastomoses performed on irradiated tissue
• Anastomotic leak with peritonitis sepsis

However it is usually reserved as a last resort for patients with:^[2][3]

• History of unresponsiveness to medical or endoscopic treatment
• History of intractable symptoms/complications like stricture, pain, bleeding, perforation, or a fistula

Surgical options for radiation proctitis include:

• Excision
• Urinary and fecal diversion (diverting stoma) and
• Reconstruction of a coloanal J reservoir