[Postoperative fistulas. How to close them].
Postoperative enterocutaneous fistulas are usually the result of an anastomotic leak. The likelihood of a postoperative fistula developing depends on concomitant diseases. An established gastrointestinal fistula is associated with considerable morbidity and mortality. Appreciable losses of fluid, protein and electrolytes often result in malnutrition, which has a negative impact on wound infection and the mental performance of the patient. Conservative treatment must aim to compensate these deficits as early as possible. Adequate amounts of energy (carbohydrates and fats) vitamins and trace elements must be ensured by replacement measures. In addition to appropriate drainage of the intra-abdominal focus and the use of antibiotics, treatment with octreotide (somatostatin analogues) may be considered. For conservative treatment, however, free intestinal transit distal to the fistula must be ensured. If an enterocutaneous fistula fails to heal within two or three months under conservative treatment, surgical management must be applied.
Baumgartner
U
U
Abt. Allgemein- und Viszeralchirurgie mit Poliklinik, Chirurgische Universitätsklinik Freiburg.
D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004750:Enteral Nutrition; D005747:Gastric Fistula / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006728:Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D009748:Nutrition Disorders / Q000150:complications / Q000517:prevention & control; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D011379:Prognosis; D013004:Somatostatin / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D014131:Trace Elements / Q000008:administration & dosage; D014815:Vitamins / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D005765:Gastrointestinal Agents; D006728:Hormones; D014131:Trace Elements; D014815:Vitamins; D013004:Somatostatin; D015282:Octreotide