Selective occlusion with fibrin glue under fistuloscopy: seven cases of postoperative management for intractable complex fistulas.
OBJECTIVE
Fistula occlusion is not achieved in some fistulas with complex branches. To obtain early fistula closure in such cases, we insert a double-lumen catheter into each fistula branch, with the aid of a guide wire positioned using a small-caliber endoscope, and attempt selective infusion of fibrin glue.


METHODS
Following removal of foreign bodies and necrotic granulation, we applied the selective occlusion method under fistuloscopic control to seven intractable external fistulas with complex branches, in which fistula closure had not been obtained by a simple occlusion method (SOM). All the fistulas were complex with more than two branches.


RESULTS
Fistula occlusion was obtained within 2 weeks in six of the seven patients, and there has been no sign of recurrence over a follow-up period of 4 - 59 months (average 29.8 months).


CONCLUSIONS
Selective occlusion under fistuloscopy is highly effective for intractable external fistulas with complex branches.
Kurokawa
T
T
Surgical Oncology, Division of Cancer Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan. t-kuro@med.hokudai.ac.jp
Okushiba
S
S
Kadoya
M
M
Miyamoto
D
D
Kurashima
Y
Y
Kitagami
H
H
Ikeda
J
J
Sunaga
M
M
Shinzato
Y
Y
Ozawa
T
T
Kondo
S
S
Katoh
H
H
D013505:Digestive System Surgical Procedures; D016099:Endoscopy, Gastrointestinal; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D005402:Fistula / Q000628:therapy*; D006801:Humans; D011183:Postoperative Complications / Q000628:therapy*; D014014:Tissue Adhesives / Q000008:administration & dosage*
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives