Managing Refractory Postoperative Fistulas as Chronic Wounds Using Video-Assisted Hydrodebridement (VAHD)

Postoperative fistula formation remains a serious complication following abdominal surgical procedures. Refractory fistulas requiring further surgical intervention delay adjuvant chemotherapy and functional recovery. Here, we present six cases of refractory fistulas and describe a new management technique, which we call video-assisted hydrodebridement. We postulate that refractory fistulas are a type of chronic wound, for which hydrodebridement may be used to hasten wound healing. In all cases, patients had undergone a prolonged period of conservative management and surgical intervention was not considered appropriate. Here, we describe the steps of the procedure in detail. We achieved timely closure of the refractory fistula in five of six cases. The median duration of attempted conservative management was 122 days (63-346 days) and median time to fistula closure after the procedure was 35 days (22-64 days) in the five successful cases. The findings during each procedure are discussed. We suspect that this procedure applies the same benefits to refractory fistulas that hydrodebridement provides to chronic wounds. The combination of endoscopic exploration and hydrodebridement can elucidate barriers to fistula resolution while creating a clean base for wound healing. This technique may be a useful tool to reduce the morbidity of refractory fistula management.