Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined Vicryl plug and fibrin glue.
BACKGROUND
The incidence of clinically relevant anastomotic leaks after upper gastrointestinal surgery is approximately 4% to 20%, and the associated mortality is up to 80%. Depending on the clinical presentation, the treatment options include surgery, conservative treatment with or without external drainage or endoscopic treatment.


METHODS
This report presents nine cases of anastomotic leaks or fistulae after surgery for upper gastrointestinal cancers that were treated by insertion of a Vicryl plug and sealing with fibrin glue. Under sedation, all nine patients underwent endoscopic lavage of the cavity at the site of anastomotic leakage. The entrance to the cavity then was filled with Vicryl mesh and sealed off with fibrin glue. After the procedure, the patients underwent endoscopy and a water-soluble contrast study for assessment of the result.


RESULTS
Seven of the nine patients had complete healing of the anastomotic leak or fistula after one to two endoscopic treatments. In one case, the treatment failed immediately because of a large and direct tracheoesophageal fistula. Another patient experienced recurrent intrathoracic abscesses after initial technical success.


CONCLUSIONS
Postoperative upper gastrointestinal fistulas or anastomotic leaks can be managed successfully with little morbidity by means of endoscopic insertion of Vicryl mesh with fibrin glue, thereby avoiding repetitive major surgery and its associated risks.
Truong
S
S
Department of Surgery, University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
Böhm
G
G
Klinge
U
U
Stumpf
M
M
Schumpelick
V
V
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery; D002277:Carcinoma / Q000601:surgery; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D016145:Endoscopy, Digestive System; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D005743:Gastrectomy; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery*; D005763:Gastroenterostomy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011098:Polyglactin 910; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery; D013526:Surgical Mesh; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014138:Tracheoesophageal Fistula / Q000209:etiology; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D011098:Polyglactin 910