Postoperative external alimentary tract fistulas

Most series dealing with external gastrointestinal fistulas cover experience of many years and include a heterogeneous sample of fistulas. We present our experience with 117 cases of postoperative external alimentary tract fistulas treated since 1980. Only fistulas caused by anastomotic leaks and operative injury to bowel are included. The overall mortality rate was 37%. The fistulas are classified into four types: type I-abdominal, esophagus, gastroduodenal (mortality rate, 17%); type II-small bowel (mortality rate, 33%); type III-large bowel (mortality rate, 20%), and type IV-all sites associated with a large abdominal wall defect (mortality rate, 60%). The main cause of death was intra-abdominal infection. Seventy-six percent of the patients required further operations. We conclude that despite the availability of all modern diagnostic and management facilities, postoperative external gastrointestinal fistulas treated during the 1980s continue to represent a surgical "disaster." Only prevention and improved methods in the management of the associated intra-abdominal infections could improve the results.