Postoperative external alimentary tract fistulas

Schein, Moshe; Decker, G

doi:10.1016/0002-9610(91)91107-t

Cited by 70 publications

(56 citation statements)

References 18 publications

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“…The relatively low overall mortality rate of 14.1% in the present study compares favourably with rates of 15-35% reported in the literature [9][10][11][12][13]. Mortality was related to sepsis, age, sex, fi stula output and preoperative albumin We used octreotide in all cases of high output fi stulae and found a signifi cant reduction in the fi stula output within the fi rst 48 hours.…”

Section: Discussionsupporting

confidence: 76%

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Small bowel enterocutaneous fistulae: the merits of early surgery

Gupta

Sonar²,

Kakodkar³

et al. 2008

Indian J Surg

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Background The treatment of patients with small bowel enterocutaneous fi stulas is complex and a challenge for every surgeon. The mortality and morbidity associated with only conservative management is often high and expensive because most patients cannot afford prolonged parenteral nutrition which itself carries a high incidence of complications. Although operations are diffi cult if performed early they may be lifesaving in our situation. The focus of our study was to determine whether, in patients with fi stulae, early intervention resulted in low mortality and morbidity rates and to identify prognostic factors for fi stula closure and mortality.

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Section: Discussionsupporting

confidence: 76%

“…At present, the treatment of patients with an abdominal wall defect in which a fi stula develops in the exposed intestine is probably the biggest challenge [8]. The few retrospective studies available in the literature concerning these patients are either incomplete or only describe small numbers [9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Small bowel enterocutaneous fistulae: the merits of early surgery

Gupta

Sonar²,

Kakodkar³

et al. 2008

Indian J Surg

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“…Since the advent of TPN, mortality from ECFs has decreased significantly. Early studies reported mortality rates of up to 65% with high output fistulas [12], although in most cases mortality ranged from 6.5 to 37% [13,14,15,16]. Mortality is decreasing mainly because of advances in the care of critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Postoperative Enterocutaneous Fistulas by High-Pressure Vacuum with a Normal Oral Diet

Medeiros

Aires-Neto²,

Marchini³

et al. 2004

Dig Surg

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Background/Aims: Enterocutaneous fistulas are associated with prolonged hospital stay, high morbidity/mortality, and increased hospital costs. This study aims to describe the use of a vacuum system and normal oral diet in dealing with this problem. Methods: Seventy-four consecutive patients with recent and defined external postoperative fistulas were analyzed. Abdominal imaging was used to exclude abscess and distal obstruction. The fistula tract was sealed with Foley catheter, connected to a negative pressure flask, changed daily for 5, 10 or 15 days, as necessary. A normal oral diet was permitted. Results: No patient died. Serum albumin and transferrin showed significantly higher levels at the end of treatment than at the beginning. The moderate and low-output fistulas had the best results (97% closed). Forty-eight (65%) fistulas closed after 5 days, 16 (22%) after 10 days and 4 (5%) after 15 days. Treatment failed in 6 (8%) patients, who subsequently underwent surgery. The fistula did not close in 1 patient with a low output. The cost of the treatment was USD 41.75/day and it was considered cost-effective. Conclusions: The vacuum system demonstrated good results in the treatment of fistulas. It included simplicity, low cost, short hospital stay, absence of skin breakdown, normal eating, good nutrition and activity patterns.

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“…This classification, however, fails to cover all the various aspects and, for instance, is hardly suitable for pancreatic fistulas where an output of 1,000 cm 3 in 48 h represents an exceptional event. The difficulty in classification is made even more complex by the fact that, on the one hand, a clinically unimportant biliary secretion of only a few cm 3 can be defined as a fistula, while, on the other, an intra-abdominal collection secondary to anastomotic dehiscence causing septic shock with consequent death of the patient is also often attributable to the formation of a fistula [2].…”

Section: Introductionmentioning

confidence: 99%