J reconstr Microsurg 2019; 35(07): 479-484
DOI: 10.1055/s-0039-1679880
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Flap Reconstruction of Gastrointestinal-to-Genitourinary Fistulas: A 20-Year Experience

1  Mayo Clinic School of Medicine, Rochester, Minnesota
Ziyad S. Hammoudeh
2  Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
Arya A. Akhavan
1  Mayo Clinic School of Medicine, Rochester, Minnesota
Nho V. Tran
2  Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
Funding None.
Further Information

Publication History

25 July 2018

14 January 2019

Publication Date:
21 February 2019 (online)


Background Gastrointestinal-to-genitourinary fistulas may occur secondary to obstetric complications, radiation therapy, cancer without radiation, inflammatory bowel disease, or previous surgery. Flap reconstruction is useful for complex cases refractory to standard techniques, separating the fistula tracts to aid healing. The purpose of this study was to investigate outcomes and risk factors for complications in flap reconstruction of fistulas from several different etiologies performed over a 20-year period.

Methods All patients who underwent flap reconstruction between January 1995 and December 2014 were reviewed. Patient demographics, prior treatment failures, surgical indications, and comorbidities were obtained. Operative and postoperative data were collected, including flap type, length of stay, early and late complications, recurrences, and follow-up time. Operative success was defined as definitive treatment of the fistula without recurrence within 6 months.

Results There were 59 patients who underwent 66 reconstructions. The overall complication rate was 59.1%. Complications included infection (21%), dehiscence (17%), and partial flap loss (1.5%). Operative success rate was 51.5%. Smoking history (p = 0.021) and body mass index (BMI) > 35 (p = 0.003) were significantly associated with increased likelihood of postoperative complications following flap reconstruction in these patients. Additionally, fistulas due to cancer resections had a higher likelihood of postoperative complications compared with fistulas due to bowel disease or obstetric complications (p = 0.04).

Conclusion Flap reconstruction can be successfully used for complex or refractory gastrointestinal-to-genitourinary fistulas. However, considerable complication and recurrence rates were found in this population. Patients with a BMI > 35 and a history of smoking were at greatest risk in this cohort of experiencing postoperative complications.


This study was presented as a full Podium presentation at the American Society of Plastic Surgeons Annual Meeting–Plastic Surgery: The Meeting, Orlando, FL, October 6–10, 2017.