Endoscopic treatment of postoperative fistulas resistant to conservative management using biological fibrin glue.
OBJECTIVE
Postoperative fistulae occur frequently in standard surgical practice, but there is no general agreement on how to treat them. We summarize here our experience with endoscopic treatment.


METHODS
Postoperative digestive fistulae resistant to conservative treatment, in 15 patients, are retrospectively reviewed. Our series included two internal fistulas: (one rectovesical, and one high-output pleuroesophagic), and 13 external fistulas (one low-output gastrocutaneous, two low-output esophagocutaneous, seven low-output enterocutaneous, and three high-output enterocutaneous). After failure of conservative treatment, the fistulas were endoscopically located and 2 - 4 ml of reconstituted fibrin glue, Tissucol 2.0 at 37 degrees C, was injected through a catheter.


RESULTS
The mean age of the patients was 61.2 years (38 - 86), and 60 % were men. Of the fistulas, 26.6 % were of the high-output type. The mean healing time was 16 days (5 - 40), and a mean of 2.5 sessions per patient were required (1 - 5). Complete sealing of fistulas was achieved in 86.6 % of cases; (87.5 % of the low-output and internal fistulas, and 55 % of the high-output fistulas). After follow-up ranging between 2 months and more than 3 years, only one of the sealed fistulas reopened. No complications were encountered. Overall mortality was 13.3 % (two out of 15), but in only one patient was this related to clinical deterioration because of the persistence of the fistula.


CONCLUSIONS
We think that conservative treatment should not be prolonged beyond 14 days and that endoscopic treatment should be performed at that stage. Endoscopic sealing treatment achieves a very high success rate, without complications and at a lower cost. It could probably reduce the hospital stay, and avoid some unnecessary surgical interventions. Appropriate multicenter randomized trials are needed to confirm these results.
Rábago
L R
LR
Department of Gastroenterology, Hospital Severo Ochoa Leganés, Madrid, Spain. Irabagot@meditex.es
Ventosa
N
N
Castro
J L
JL
Marco
J
J
Herrera
N
N
Gea
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016154:Digestive System Fistula / Q000401:mortality / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D015718:Fibrin Tissue Adhesive; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive