External gastrointestinal fistula after the advent of total parental nutrition

From 1984 to 1988, 173 patients with 190 external gastrointestinal fistulae and given total parenteral nutrition (TPN) were reviewed. The advent of TPN has enabled the patients to be operated in a better condition under a well-planned procedure, and has therefore modified the principle of surgical intervention. However, no significant improvement has been noted in the mortality rate and spontaneous closure rate as compared with the years without TPN. The diseases have changed in pattern to afflict older population and increase the incidence of complicated fistula because of the more sophisticated surgery. It may also have something to do with delayed intervention of the intraabdominal abscess and delayed surgical closure of the fistula due to TPN administration. Early and aggressive treatment against intraabdominal infection, and early closure of the fistulae which fail to close spontaneously with 6-week conservative treatment after subsidence of infection, are advocated.