Diagnostic and Therapeutic Fistuloscopy: An Adjuvant Management in Postoperative Fistulas and Abscesses after Upper Gastrointestinal Surgery

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