[A new conservative approach in the treatment of postoperative digestive-tract fistulas. Mechanical closure by a balloon-catheter].
BACKGROUND
Digestive fistulas represent troublesome complication in patients operated in modern surgical wards where the improved surgical procedures and better intensive care enhance the surgeon to perform more aggressive approaches with a high surgical risk index. The management of a patient presenting a digestive-tract fistula is never easy, being its approach either conservative (TPN) or surgical. We applied an alternative surgical procedure consisting in a mechanical closure of the fistula using a balloon-catheter so as to improve outcome in those patients in whom medical tratment did not show satisfactory RESULTS.


METHODS
We treated 7 patients presenting a postoperative fistula following several surgical procedures for neoplasms of the digestive system. These fistulas were closed using a Foley or Fogarthy balloon catheter preceeded by radiological and/or endoscopy controls. Once the catheter was placed, oral nutrition was started and some patients were discharged. A progressive deflation of the balloon was performed until complete removal of the catheter upon approx 10 days.


RESULTS
We obtained a complete healing of the fistula in 6 patients, within 10 days since catheter placement. Only one patient required another operation.


CONCLUSIONS
Our case-series may seem statistically not significant, but varied concerning location and type of fistulas. We observed an excellent outcome using this procedure which allows very short healing period thanks to an early oral nutrition uptake and a decrease in costs mainly due to a short hospital stay and a minor use of expensive drugs (TPN).
II U.O. Chirurgia Generale ASL 4, Prato, Italy.
M
M
Farsi
M
M
Campaioli
G
G
Caldini
A
A
Sarteanesi
G
G
Picchi
A
A
Sanna
F
F
Menici
P
P
Favi
D000368:Aged; D002404:Catheterization; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*