Treatment of digestive fistulas|IL TRATTAMENTO DELLE FISTOLE DIGESTIVE

Abstract Records of 126 consecutive patients affected by digestive fistulas observed during the period 1981-1992 were retrospectively reviewed. The aim was to evaluate respective results of nutritional and surgical treatment, with special reference to location of fistulas and association with intra-abdominal sepsis. Overall 59 patients (46.8%) were transferred from other hospitals. One hundred and twenty patients were treated medically; most of them (103) received total parenteral nutrition (TPN); 5 received enteral nutrition (EN) and 12 TPN + EN. Six additional patients underwent immediate surgical repair. Closure rate with nutritional treatment only was 31% (n. 39): 39.2% (n. 33) for upper gastrointestinal tract (UGT) and small bowel fistulas and 14.28% (n. 6) for those located in the large bowel (p < 0.001). Definitive surgical repair was necessary in 39.7% of cases (n. 50): 28.5% (n. 24) for UGT and small bowel fistulas and 62% (n. 26) for colonic fistulas (p < 0.001). Mortality rate was 24.6% (n. 31); it was proved to be increased in case of sepsis (57.14% versus 3.8%, p < 0.001), malnutrition (33.3% versus 14.03%, p < 0.009), location of the fistulas in the UGT and small bowel (32.14% versus 9.53%, p < 0.003) and output > 200 cc (40.54% versus 17.6%, p < 0.001). Results suggest that the treatment of digestive fistulas should include early control of infections and appropriate nutritional support. An earlier surgical approach for patients with large bowel fistulas is suggested.