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Colonial Wig Pancreaticojejunostomy

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Postoperative external alimentary tract fistulas.

M Schein¹, G A Decker

¹Department of Surgery, J.G. Strijdom Hospital, Johannesburg, South Africa.

American Journal of Surgery

|April 1, 1991

Summary

Postoperative external gastrointestinal fistulas are a significant surgical challenge, with a 37% mortality rate. Improved prevention and infection management are crucial for better outcomes in treating these complex fistulas.

Area of Science:

Gastroenterology
Surgical Oncology
Abdominal Surgery

Background:

External gastrointestinal fistulas present complex management challenges.
Previous studies often include diverse fistula types and long-term data.
This study focuses on a specific cohort of postoperative fistulas.

Purpose of the Study:

To analyze the experience with 117 cases of postoperative external alimentary tract fistulas.
To classify fistulas and assess mortality rates based on type and location.
To identify key factors contributing to mortality and guide future management strategies.

Main Methods:

Retrospective review of 117 patients treated for postoperative external alimentary tract fistulas since 1980.
Inclusion criteria: fistulas caused by anastomotic leaks and operative bowel injury.

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Classification into four types based on anatomical location and associated defects.

Main Results:

Overall mortality rate was 37%.
Type IV fistulas (associated with large abdominal wall defects) had the highest mortality (60%).
Intra-abdominal infection was the primary cause of death; 76% of patients required reoperation.

Conclusions:

Postoperative external gastrointestinal fistulas remain a significant surgical complication.
Prevention and enhanced management of intra-abdominal infections are critical for improving outcomes.
Despite advances, these fistulas represent a serious challenge requiring specialized care.