Background and Study Aims: Postoperative fistulas and abscesses pose difficult management problems. We report our experience in the use of fistuloscopy in postoperative fistulas and abscesses after upper gastrointestinal surgery.
Patients and Methods: From June 1993 to January 1997, nine patients (seven men, two women; mean age 65) with postoperative fistulas and abscesses were treated with therapeutic fistuloscopy. Diagnostic fistuloscopy was carried out using a 5-mm choledochoscope under fluoroscopic guidance. Therapeutic procedures included mechanical debridement, irrigation, and sealing of fistula with fibrin sealant and gelatin sponge.
Results: The patients were suffering from duodenal stump fistula (three cases), gastrojejunostomy dehis-cence after gastrectomy (three cases), gastropleurocutaneous fistula (two cases), and subphrenic abscesses (two cases). Fistuloscopy was performed 4 - 19 days (mean 12 days) after the diagnosis of the fistula. The median number of sessions required was 2 (range 1 - 4). The average daily fistula output prior to fistuloscopy was 154 ml (range 30 - 560 ml), and all fistulas healed in an average of 18.7 days (range 2 - 46 days) after index fistuloscopy. No procedure-related complications occurred. The mean hospital stay was 61 days. During a mean follow-up period of 12 months, no recurrent abscesses or fistulas developed.
Conclusions: Fistuloscopy provides a new means of managing patients with postoperative fistula and abscess formation.
References
-
1
Torres A J, Landa J I, Morenza-Azcoita M, et al.
Somatostatin in the management of gastrointestinal fistula. A multi-center trial.
Arch Surg.
1992;
127
97
-
2
Chung M A, Wanedo H J.
Surgical management and treatment of gastric and duodenal fistulas.
Surg Clin N Am.
1996;
76
1137-1146
-
3
Nakagawa K, Momono S, Sasaki Y, et al.
Endoscopic examination of fistula.
Endoscopy.
1990;
22
208-210
-
4
Marone G, Santoro L M, Torre V.
Successful endoscopic treatment of GI-tract fistulas with a fast-hardening amino-acid solution.
Endoscopy.
1989;
21
47-49
F.R.C.P. F.R.C.S. M.D. S.C.S. Chung
Endoscopy Centre, Prince of Wales Hospital The Chinese University of Hong Kong
Shatin, New Territories, Hong Kong
Phone: + 852-2635-0075
Email: sydneychung@cuhk.edu.hk
