Diagnostic and therapeutic fistuloscopy: an adjuvant management in postoperative fistulas and abscesses after upper gastrointestinal surgery.
OBJECTIVE
Postoperative fistulas and abscesses pose difficult management problems. We report our experience in the use of fistuloscopy in postoperative fistulas and abscesses after upper gastrointestinal surgery.


METHODS
From June 1993 to January 1997, nine patients (seven men, two women; mean age 65) with postoperative fistulas and abscesses were treated with therapeutic fistuloscopy. Diagnostic fistuloscopy was carried out using a 5-mm choledochoscope under fluoroscopic guidance. Therapeutic procedures included mechanical debridement, irrigation, and sealing of fistula with fibrin sealant and gelatin sponge.


RESULTS
The patients were suffering from duodenal stump fistula (three cases), gastrojejunostomy dehiscence after gastrectomy (three cases), gastropleurocutaneous fistula (two cases), and subphrenic abscesses (two cases). Fistuloscopy was performed 4-19 days (mean 12 days) after the diagnosis of the fistula. The median number of sessions required was 2 (range 1-4). The average daily fistula output prior to fistuloscopy was 154 ml (range 30-560 ml), and all fistulas healed in an average of 18.7 days (range 2-46 days) after index fistuloscopy. No procedure-related complications occurred. The mean hospital stay was 61 days. During a mean follow-up period of 12 months, no recurrent abscesses or fistulas developed.


CONCLUSIONS
Fistuloscopy provides a new means of managing patients with postoperative fistula and abscess formation.
Wong
S K
SK
Dept. of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, SAR, China.
Lam
Y H
YH
Lau
J Y
JY
Lee
D W
DW
Chan
A C
AC
Chung
S C
SC
D000038:Abscess / Q000209:etiology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005747:Gastric Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007579:Jejunal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013272:Stomach Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery; D014014:Tissue Adhesives; D016896:Treatment Outcome
D014014:Tissue Adhesives