A technique for the operative closure of persistent external small-bowel fistulas

This paper presents a technique for the operative closure of persistent small-bowel fistulas. This is a radical procedure involving complete dissection of the whole of the small intestine, resection of the segment of bowel containing the fistula, and primary two-layer anastomosis. A consecutive series of 50 patients with small-bowel fistulas in presented. Twenty-three required surgery, seven of whom underwent a procedure soon after the establishment of the fistula, and in only two of these was the fistula successfully closed. The other 16 patients underwent surgery some two months after establishment of the fistula, free of sepsis and in a sound nutritional state. In fifteen patients the fistula was successfully closed, and the other has a persistent fistula which is of nuisance value only.