Therapeutic fistuloscopy: an alternative approach in the management of postoperative fistulas.
OBJECTIVE
Since the treatment of postoperative fistulas remains a difficult problem, we applied endoscopic treatment in such 14 persistent fistulas.


METHODS
Fourteen patients presented with postoperative fistulas: 7 patients (low-output group) due to residual cavity after liver hydatid disease surgery and 7 patients (high-output group) after small-bowel resection (n = 3), diverted duodenostomy (n = 1), vertical gastroplasty (n = 1), external pancreatic cyst drainage (n = 1), and transduodenal sphincteroplasty (n = 1). The therapeutic procedures included mechanical removal of silk sutures, necrotic material, and hydatid membranes in the low-output group and fibrin sealing in the high-output group.


RESULTS
Fistuloscopy was performed 170-278 days (mean +/- SD 198.7 +/- 36.7 days) and 18-51 days (mean +/- SD 34.0 +/- 11.3 days) postoperatively in low- and high-output fistula patients, respectively, when the average daily output was 20-50 (32.8 +/- 12.5) ml and 200-1,000 (563.1 +/- 319.4) ml, respectively. The low-output group needed only one fistuloscopy session, while the other group required a median number of three sessions plus fibrin sealing, the total amount of fibrin glue used per patient being 2-14 (6.5 +/- 4.4) ml. No procedure-related complication occurred. All fistulas except one healed within 10-33 (21.8 +/- 7.9) days and 2-17 (9.2 +/- 5.1) days in low- and high-output groups, respectively.


CONCLUSIONS
We believe fistuloscopy to be a useful tool in the management of gastrointestinal fistulas, but more experience should be gained in using this technique.
Eleftheriadis
Efthimios
E
Department of Surgery, University of Thessaloniki Medical School, Greece. elemakis@med.auth.gr
Kotzampassi
Katerina
K
D000328:Adult; D000368:Aged; D016154:Digestive System Fistula / Q000628:therapy*; D004385:Duodenostomy; D004444:Echinococcosis, Hepatic / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D015391:Gastroplasty; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000601:surgery; D011183:Postoperative Complications / Q000628:therapy; D013105:Sphincterotomy, Transduodenal
D015718:Fibrin Tissue Adhesive