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At least 37 records · Page 2Linked to original sources
PubMed2004

Socio-demographic profile and obstetric experience of fistula patients managed at the Addis Ababa Fistula Hospital.

Obstetric experience, clinical and socio-economic characteristics, and reasons for preference of place of delivery of 639 fistula patients admitted to the Addis Ababa Fistula Hospital between May 1999 and February 2000 are described About 94% of fistula patients were married and 83.6% had been through with the delivery caused the fistula before the age of 20. The mean ages at the first marriage and at the causative delivery were 14.7 (sd=2.6) and 17.8 (sd=3.2) years respectively. Mean height of fistula patients studied was 149 cms (sd=8). About 64% were primiparous, 44% (279) delivered at home, and labor lasted for 3.8 days on average. Majority of fistula patients mentioned distance as a main problem for the delays. Lack of money, poor knowledge and delay in referral were the other frequently mentioned reasons for the delays. About 62%(399) of fistula patients owned nothing valuable. Of 279 patients delivered at home 186 were those who owned nothing. Out of 180-fistula patients mentioned distance as the major problem, 103 (57%) stayed at home for delivery. About 54% of fistula patients were already divorced on arrival to the hospital and this figure varied among women with different parity and among those owning different property. Teenage and short stature are observed features of fistula patients. The study also showed the huge problems faced by fistula patients in accessing emergency obstetric care services. Analytic study is recommended to compare the magnitude of these problems among other mothers with different obstetric outcome. Meanwhile, community education about problems following teenage pregnancy, sign and symptoms of obstructed labor and the advantage of institutional delivery might reduce the occurrence rate of obstetric fistula. Community organized fund and maternity waiting areas for young and short expecting mothers are among other recommendations to be considered.

Adolescent↗
PubMed1978

[Evaluation of the fistula test and the positional test in the diagnosis of a fistula of the labyrinth (author's transl)].

111 patients with a chronic otitis media and symptoms of dizziness were investigated. Out of 75 patients, who were operated, a fistula of the labyrinth was suspected in 25 patients due to a positive fistula test or a positive (fistula) positional test. A fistula was found in 15 patients. In those 15 cases both the fistula and the positional (fistula) test were positive in nine cases. In the remaining six cases three had a positive fistula test and three a positive (fistula) positional test. The other 50 patients all with negative fistula reactions one fistula was whereas found by the operation. This would indicate, that a positive fistula test and a positive (fistula) positional test are of value in the preoperative evaluation of patients with chronic otitis media and symptoms of vertigo.

Fistula↗
PubMed1991

Parenteral and enteral nutrition and the enterocutaneous fistula treatment. I. Investigations on fistula output, nutritional status complications.

Prospective evaluation were made of 45 patients with postoperative small bowel fistulas treated with total parenteral nutrition (TPN) and enteral nutrition (EN) between 1971-1988. The administration of TPN in the early treatment of enteric fistulas decreased the mean fistula output significantly (p < 0.05-0.001) and provided an effective tool in the control of high-output fistulas. The electrolyte contents of different fistula secretions were unchanged and the losses through the fistulas depended on the daily output. In patients with high-output fistulas acid-base balance disturbances had to be corrected. When comparing two parenteral nutrition regimens (carbohydrate+amino acids /CH + AA/ versus carbohydrate + amino acids + fat /CH + AA + F/) both facilitated the reduction of fistula secretion (in high-output fistulas. CH + AA = -50.2%; CH + AA + F = -49%). Positive nitrogen balance was achieved in non septic patients after 13 days of treatment. Improvement of serum protein and albumin occurred by the time of fistula healing. In non surviving patients significant decrease in protein synthesis was observed. Out 7 of 75 central venous catheters yielded positive bacterial cultures (9.3%). In 5 patients autopsy proved generalized sepsis. The use of parenteral and enteral nutrition proved to be a powerful method for controlling the enterocutaneous fistulas and maintaining the nutritional integrity of patients.

Adult↗
PubMed2002

The fistula elevation procedure: a valuable technique for maximizing arteriovenous fistula utilization.

Many patients are not considered candidates for radiocephalic fistula (RCF) or brachiocephalic fistula (BCF) creation or have fistulas that do not mature because the cephalic vein is too deep or tortuous to be accessed. Other patients have not been candidates for the basilic vein transposition (BVT) because limited length of adequate caliber vein precludes subcutaneous tunneling of the vein. In an effort to maximize arteriovenous fistula (AVF) utilization, we developed an adjunctive procedure designed to make the deep or tortuous fistula accessible to needle cannulation. The fistula elevation procedure (FEP) involves mobilization of the fistula, approximation of the subcutaneous tissue beneath the fistula, and subcuticular skin closure over the fistula. The procedure enhances the accessibility of the fistula by placing it in a more superficial position. The overlying cicatrix also acts as a guide for dialysis needle insertion. Between June 1998 and January 2001, 45 patients underwent a natural AVF that could not be accessed secondary to venous depth, tortuosity, or length. In each case, a FEP was performed to salvage the fistula. The FEP was performed as an adjunct to a BCF in 20 patients, a RCF in 7 patients, and a BVT in 8 patients. The FEP is a simple procedure that enhances AVF utilization by making the fistula more accessible to dialysis needle cannulation. The procedure is particularly helpful in obese patients who would not traditionally be considered candidates for natural AVF creation.

Adult↗
PubMed1985

Assessment of arteriovenous fistulae from pressure and thermal dilution studies: clinical experience in forearm fistulae.

Knowledge of useful fistula flow (UFF), the maximum blood flow available using twin needles within acceptable pressure limits and without recirculation, is essential for the optimal management of patients receiving maintenance hemodialysis or hemofiltration. A technique for the measurement of UFF employing thermal dilution for the detection of recirculation has been developed. Using this technique, 94 studies were carried out in 69 forearm fistulae. UFF exceeded 400 ml/min in 45 fistulae. In these satisfactory fistulae a normal range was defined for basal intrafistula pressures (60 mmHg being the approximate upper limit of normal). Analysis of arterial and venous line pressure recordings with increasing extracorporeal blood flow and knowledge of the presence or absence of recirculation allowed us to define the functional problem in unsatisfactory fistulae. The functional diagnosis was supported in 16 of 24 fistulae by angiography or surgery or both. In all but two of the remainder, satisfactory UFF was obtained by repositioning the patients' needling sites. Fistulae were divided into different clinical groups. Of 35 fistulae which were thought to be clinically acceptable, 7 were found to be unsatisfactory. In 17 fistulae in patients with poor biochemical control, recirculation was detected in 8. Of 11 fistulae reported to produce poor flows on dialysis, 4 had UFF above 400 ml/min. Of 6 fistulae in patients experiencing needling difficulties, 5 had satisfactory UFF. These studies which take only a few minutes and can be carried out immediately preceding a routine dialysis session not only identify unsatisfactory fistulae, but yield valuable diagnostic information in these cases. This has reduced dependence on angiography and has led to more careful selection of patients for surgery.

Arteriovenous Shunt, Surgical↗
PubMed2004

Treatment for horseshoe fistulas-in-ano with primary closure of the internal fistula opening: a clinical and manometric study.

INTRODUCTION: We report on a patient cohort with dorsal horseshoe fistulas-in-ano. We sought to answer the question of whether these fistulas can be operatively treated, implementing a sphincter-preserving fistulectomy with primary closure of the internal opening, as is done when treating transsphincteric anal fistulas. Long-term clinical. course is examined here and operative methods are discussed. METHODS: During the time period from 1985 to 2000, 42 patients (29 men, 13 women) with an average age of 44 +/- 11 years were operatively treated for horseshoe fistulas-in-ano originating in cryptoglandular regions. Twenty patients originally had an abscess, which was surgically drained and then a seton was placed in the tract of the fistula. Later, a fistulectomy or curettage of the fistula tract with primary closure of the internal fistula opening was performed in all patients without severing the sphincter muscle. We implemented four different surgical techniques to facilitate this closure: the mucosa-submucosa advancement flap, the rectal wall advancement flap (part or full thickness), the anocutaneous advancement flap, and direct closure without any further mobilization. The follow-up averaged 58 months (1-14 years). RESULTS: Thirty-seven of the 42 fistulas (88 percent) healed. In 31 patients, restitution occurred after the first operation, in 4 patients after the second operation and in 2 patients after the third operation. One patient developed a recurrence after the first operation and died from secondary causes before a second operation was performed. The other four patients were listed as unclear, because the time of observation was less than one year. The total recurrence rate of flap procedures is 23 percent (mucosa-submucosa advancement flap, 25 percent; rectal wall advancement flap, 35 percent; anocutaneous advancement flap, 25 percent; direct closure, 0 percent; not significant). Thirty-four (81 percent) of the 42 patients had previously been operatively treated on an average of three times. Twelve patients developed deficits in continence. Eight patients developed minor deficits, which included incontinence for flatus and problems with staining. Four patients became incontinent for liquid stools. There was a significant decrease in manometric resting pressure of 25 percent (from 123 +/- 40 cm H2O to 91 +/- 29 cm H2O) and in squeeze pressure of 21 percent (from 262 +/- 70 cm H2O to 207 +/- 66 cm H2O). CONCLUSIONS: As in other high anal fistulas, horseshoe-shaped anal fistulas can be operatively treated implementing a fistulectomy combined with any of the above-mentioned forms of closure of the internal fistula opening, with good success rates and acceptable postoperative continence. Sufficient drainage of the retroanal region is of utmost importance. Through these measures, it is possible to avoid severing the sphincter muscle and to prevent an anal canal deformation (keyhole deformity).

Adult↗
PubMed2006

Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up.

PURPOSE: The long-term efficacy of Surgisis anal fistula plug in closure of cryptoglandular anorectal fistulas was studied. METHODS: Patients with high cryptoglandular anorectal fistulas were prospectively studied. Additional variables recorded were: number of fistula tracts, and presence of setons. Under general anesthesia and in prone jackknife position, patients underwent irrigation of the fistula tract by using hydrogen peroxide. Each primary opening was occluded by using a Surgisis anal fistula plug, which was securely sutured in place at the primary opening and tacked to the periphery of the secondary opening. RESULTS: Forty-six patients were prospectively enrolled during a two-year period. Follow-up was six months to two years (median, 12 months). At final follow-up, all fistula tracts had been successfully closed in 38 patients, for an overall success rate of 83 percent. Seven patients had multiple tracts, for a total of 55 fistula tracts in the series. Of the 55 individual tracts, 47 (85 percent) were closed at final follow-up. Patients with one primary opening were most likely to have successful closure by using the anal fistula plug, although this was not significant. Successful closure was not correlated with the presence of setons. CONCLUSIONS: Long-term closure of cryptoglandular anorectal fistula tracts using Surgisis anal fistula plug is safe and successful in 83 percent of patients and 85 percent of tracts.

Follow-Up Studies↗
PubMed1978

[Evaluation of the fistula test and the positional test in the diagnosis of a fistula of the labyrinth (author's transl)].

In 111 patients with a chronic otitis media and symptoms of dizziness the positional reactions were examined. Among 75 patients, who underwent operations later on, a fistula of the labyrinth was preoperatively expected in 25 patients according to a positive fistula pressure sign or a pathological fistula positional reaction. A positive fistula positional sign shows a contralateral beating transitory nystagmus in the head hanging position, while after rapid sit up the nystagmus is starting to beat into the ipsilateral direction. A labyrinthine fistula was operatively confirmed in 15 patients out of 25 suspicious cases. In these 15 cases both the fistula and the positional test were positive in 9 cases. 3 had a positive fistula pressure test and 3 a positive fistula positional sign. In 50 patients with negative fistula reactions only one fistula was observed during operation. These data underline the importance of both pressure and positional reactions in the prediction of labyrinthine fistulas.

Adult↗
PubMed2006

Cephalic vein measurement before forearm fistula creation: does use of a tourniquet to meet the venous diameter threshold increase the number of usable fistulas?

OBJECTIVE: To optimize forearm radiocephalic fistula success, many programs recommend a minimal cephalic vein diameter of 0.25 cm or greater on preoperative sonographic mapping. It is not established, however, whether a vein diameter before or after application of a tourniquet should be used in determining suitability for creation of a forearm fistula. METHODS: Before forearm radiocephalic fistula placement, preoperative sonographic mapping measured the cephalic vein diameter before and after application of a tourniquet. The patients fell into 2 groups: those with a pretourniquet vein diameter of 0.25 cm or greater (group 1) and those with a pretourniquet vein diameter of less than 0.25 cm that increased to 0.25 cm or greater after application of the tourniquet (group 2). The adequacy of each fistula for dialysis was determined clinically. RESULTS: Among 73 radiocephalic fistulas with known clinical outcomes, 28 were in group 1, and 45 were in group 2, on the basis of sonography. Fistula success rates were similar in group 1 patients (11 [39%] of 28) and group 2 patients (15 [33%] of 45) (P=.624, Fisher exact test). Inclusion of group 2 patients increased the number of patients recommended for placement of forearm fistulas and increased the total number of usable forearm fistulas from 11 to 26. The overall success rate of forearm fistulas was lower in women (19% versus 50%; P=.015, Fisher exact test). CONCLUSIONS: The use of a venous tourniquet increases the number of patients eligible for forearm fistulas without decreasing the adequacy rate of these fistulas. Therefore, a tourniquet should routinely be used in patients with small cephalic veins on pretourniquet evaluation.

Arteriovenous Shunt, Surgical↗
PubMed2004

Recurrent spinal fistula as result of a rare combination of a perimedullary and peridural spinal fistula: case report.

OBJECTIVES: We report on a patient with the combination of a peridural and a perimedullary spinal fistula, which manifested consecutively. The clinical course and diagnostic steps reveal important observations helpful in the management of this pathology. CASE PRESENTATION: A 61-year-old male patient presented with a six-month history of progressive weakness of the lower limbs. Magnetic resonance imaging revealed edema and dilated spinal veins of the lower thoracic spinal cord. Spinal angiography confirmed the diagnosis of spinal dural fistula at level T9 on the left. The patient underwent surgery and the fistula was surgically excised. Two months after initial improvement, the clinical symptoms of lower limb weakness recurred. On re-angiography a spinal perimedullary fistula was found at level T7 that was not apparent on the previous angiogram and on the postoperative control angiogram. The patient underwent surgery again, and the second fistula was also excised. The clinical symptoms subsequently improved. CONCLUSION: The interesting point in this case was the rare combination of a peridural and a perimedullary spinal fistula. They presented consecutively and could not be identified simultaneously on the first angiogram. Only after closure of the first fistula did the second become apparent. We believe that this may be a result of a postoperative pressure change in the venous system of the cord. After closure of the first fistula, the arterio-venous (AV) shunt of the second fistula developed gradually. The possibility of a second fistula should be considered in the presence of persistent edema of the cord on magnetic resonance imaging (MRI) and subsequent clinical deterioration.

Angiography↗
PubMed2003

Do anal fistulas in Crohn's disease behave differently and defy Goodsall's rule more frequently than fistulas that are cryptoglandular in origin?

OBJECTIVES: The complexity of anal fistulas is different in patients with and without Crohn's disease and in men and women. This may affect the localization of the internal orifice. We compared the characteristics of anal fistulas and the accuracy of Goodsall's rule in predicting the position of the internal orifice in male and female Crohn's and non-Crohn's patients. METHODS: A total of 191 fistula tracks in 182 consecutive patients (110 men and 72 women) were analyzed prospectively. Of the patients, 63 were diagnosed with Crohn's disease. The positions of the orifices were recorded and the accuracy of Goodsall's rule determined. RESULTS: The distribution of fistula subtypes among Crohn's and non-Crohn's patients differed significantly (p = 0.0471). Fistulas with an anterior external opening occurred more frequently in Crohn's patients (p = 0.0350) and in women (p = 0.0030). Fistulas with a posterior external orifice were observed more frequently in non-Crohn's patients (p = 0.0350) and in men (p = 0.0028). Overall, Goodsall's rule performed less well in women compared with men (p = 0.0633). The accuracy of Goodsall's rule overall was not affected by Crohn's disease. In female non-Crohn's patients, the positive predictive value of a posterior external orifice was lower than in men (p = 0.0406). CONCLUSIONS: The distribution of fistula subtypes and the ratio of anterior and posterior external openings among Crohn's and non-Crohn's patients differ significantly. Many fistulas defy Goodsall's rule, particularly in women and when applied to fistulas with anterior external orifices. The popular rule, however, falls equally short in Crohn's and non-Crohn's fistulas.

Adolescent↗
PubMedDate not supplied

Postoperative pancreatic fistula following distal pancreatectomy for pancreatic neoplasm; can pancreatic fistula be prevented?

BACKGROUND/AIMS: Pancreatic fistula is a potentially fatal complication in pancreatic surgery. The objective of this study was to analyze the incidence of pancreatic fistula in patients who underwent distal pancreatectomy for pancreatic neoplasm. METHODOLOGY: Forty-seven patients who underwent distal pancreatectomy for neoplasm of the pancreas at Kochi Medical School between October 1981 and December 2002 were studied. Comparative analysis was carried out to identify the correlations between the incidence of pancreatic fistula and parameters of preoperative evaluation, intraoperative procedure, and postoperative laboratory investigation. RESULTS: The incidence of pancreatic fistula in patients who underwent distal pancreatectomy for pancreatic neoplasm was 27.7%. Intraoperatively, the frequency of pancreatic fistula was significantly high in patients who underwent distal pancreatectomy without lymph node dissection and ligation of the splenic artery. No significant difference was recognized between the conventional surgical division and auto suture staple groups, however, in the ultrasonically activated scalpel (USAS) group, no pancreatic fistula was observed. A multivariate analysis revealed that independent high incidence of pancreatic fistula were 1) the situation of the tumor at pancreatic body, 2) the procedure of D2 lymph node dissection, and 3) the ligation of the root of splenic artery. In the group with the presence of pancreatic fistula, the serum amylase level on the first postoperative day was significantly higher than that in the group without fistula. CONCLUSIONS: Our findings supported that pancreatic fistula may be preventable by use of the USAS and treatment of acute pancreatitis in the early postoperative stage.

Adult↗
PubMed1989

[Postoperative recurrence of esophago-tracheal fistula. Significance of peroperative catheterization of the fistula with tracheoscopy. Apropos of 10 cases].

Ten children with recurrent tracheo-oesophageal fistula have been treated over 13 years (1976-1988). Five patients were referred from other centers. The original pathology was oesophageal atresia in eight and two patients had a tracheo-oesophageal fistula alone. Barium swallow demonstrated the recurrent fistula in only five of eight cases. In fact, the key examination is tracheoscopy providing that catheterisation of the fistula. The position of the catheter is verified radiologically. The difficulties of surgery in recurrent fistula are linked to the problem of locating the level of the fistula peroperatively. Without catheterisation of the fistula, there were one failure out of three cases (one dead). By contrast, in the seven cases where the fistula was catheterised, a successful outcome was always obtained. The failure of surgery for recurrent tracheo-oesophageal fistula is not linked to a technical problem of closure of the fistulous tract but to failure to localize the fistula adequately.

Adolescent↗
PubMed1986

Comparison of autogenous fistula versus expanded polytetrafluoroethylene graft fistula for angioaccess in hemodialysis.

A hundred patients with RCAV fistulas we compared with 100 patients with expanded PTFE fistulas created during the same time period. The fistulas were analyzed to compare early and late thrombosis, life table patency, infection rate, venous hypertension, and vascular steal. There was a significantly greater incidence of early thrombosis in the RCAV fistula group. Late thrombosis was seen with equal frequency in both groups. Thirty month patency by life table analysis favored the RCAV group to a significant degree, whereas infections, pseudoaneurysms, venous hypertension, and vascular steal were all more common in the expanded PTFE group. The RCAV fistula remains the ideal form of access but it is less frequently available for women and patients with peripheral vascular disease. Utilization of the expanded PTFE loop fistula requires closer observation and maintenance to keep it functional. Improved methods of patient selection for RCAV fistula using ultrasonographic imaging may allow for increased use of this form of access. Improvement in early patency in RCAV fistulas will magnify the superiority of RCAV fistulas in comparison to expanded PTFE fistulas, however, a prolonged period of venous maturation may be necessary to improve early function.

Adolescent↗
PubMed2003

Gastrostomy tube insertion into intestinal-cutaneous tract fistulas is a new technique to improve fistula control.

BACKGROUND: The management of gastrointestinal-cutaneous fistulas may be complicated by the difficulty in obtaining adequate control of the fistula tract. This study describes a new method to obtain better fistula control utilizing a semi-rigid stent in the form of a gastrostomy tube. METHODS: Consecutive patients with intestinal-cutaneous fistulas of at least 3 weeks duration and treated by the new technique were analyzed. The technique involved the insertion of a guide wire into the fistula tract from the luminal side using an endoscope, snaring the wire with a Dormia basket inserted into the fistula tract from the cutaneous side and then exteriorized. The gastrostomy tube was then pulled with the guide wire from the lumen along the fistula tract and out through the skin. RESULTS: Five patients had had fistulas for a median duration of 42 (range 26-140) days before insertion of the gastrostomy tube. The gastrostomy tube was replaced with a smaller diameter tube in 4 of the patients (range 1-3 changes). The patients were discharged from the hospital at a median of 14 (range 12-23) days after the tube insertion but with the tube in situ. The median time from the insertion of the tube to its removal was 42 (range 32-108) days. CONCLUSIONS: Gastrostomy tube insertion using minimally invasive techniques may improve fistula control enabling patients to be discharged home sooner than otherwise and improve the rate of healing.

Adult↗
PubMed1989

[Study of postoperative bronchopleural fistulas--analysis of factors related to bronchopleural fistulas].

Postoperative bronchopleural fistulas, although reduced in incidence, remain as a grave complication of pulmonary resection. In our department, cases of lung cancer have been rapidly increasing and those of infectious diseases have been decreasing. In light of this trend, the causes of bronchopleural fistulas may have changed, and thus we studied recent cases of postoperative bronchopleural fistulas from 1982 to 1986. Bronchopleural fistulas were seen in 5 (7.8%) of 64 cases of inflammatory diseases and in 19 (4%) of 481 cases of lung cancer. In lung cancer, bronchopleural fistulas were more frequently seen with advanced cases, especially in cases of residual tumors on the stump and in cases of intrathoracic use of anticancer drugs. The highest incidences of bronchopleural fistulas were seen with right pneumonectomy and right lower lobectomy. Bronchoscopic examination showed bronchopleural fistulas to be mainly located on the stump beside the residual lobe. When Sweet's procedure is employed, this is the point with the most tension on the stump. Clinical and retrospective analysis of preoperative data revealed the following factors to be significantly higher in cases of bronchopleural fistulas than in cases of non-bronchopleural fistulas: fever, use of steroid hormone, Haemophilus influenzae in sputum, elevation of erythrocyte sedimentation ratio and anemia. Such analysis of postoperative data showed the following factors to be significant: fever, use of steroid hormone, leucocytosis, tracheostomy and bronchoscopy for sputum suction.

Adolescent↗
PubMed2002

Complete discontinuity of the distal fistula tract from the developing gut: direct histologic evidence for the mechanism of tracheoesophageal fistula formation.

The embryogenesis of tracheoesophageal anomalies remains controversial. The purpose of this study was to better define the embryogenesis of developing esophageal atresia with tracheoesophageal fistula (EA/TEF), with specific attention to the controversial issue of whether a discontinuity exists in the foregut during its development of EA/TEF. Pregnant outbred rats were injected with adriamycin (2 mg/kg i.p.) on days 6-9 of gestation (E6-E9). At E12.5 and 13.5, microdissection of the entire foregut was performed. Foreguts were examined by phase microscopy, and serial, precisely transverse sections were created for hematoxylin and eosin (H&E) staining. Gross microdissection of the developing foregut at E12.5 (n = 9) revealed a blind-ending, bulbous fistula tract arising from the middle branch of the tracheal trifurcation (as seen by direct and phase microscopy). No connection with the gut could be appreciated at E12.5, but by E13.5 (n = 10) there was an obvious connection between the fistula and the stomach. Serial H&E transverse sections also demonstrated a blind-ending fistula tract arising from the trachea at E12.5. This fistula tract was clearly discontinuous from the developing stomach, which appeared much further caudal to the end of the fistula tract. These results strongly support a model of experimental TEF wherein the fistula tract arises from a trifurcation of the trachea, and (only during a specific gestational window between days 12.5 and 13.5) there is discontinuity between the fistula tract and the stomach. By day 13.5, the fistula joins with the stomach anlage. These observations in the developing EA/TEF should help to resolve the controversy about the mechanism of EA/TEF formation.

Animals↗
PubMedDate not supplied

Primary conservative management of external small-bowel fistulas. Changing composition of fistula series?

A primary conservative approach was used in treatment of 42 patients with 45 external small-bowel fistulas. Closure of fistula was achieved in 29 patients but failed in 13 (10 died and 3 discharged with open fistula). There was no time-related improvement in closure rate or mortality, probably because of a general shift towards more serious cases. To evaluate this concept more specifically, groups of simple (19) or complicated (23) fistula were distinguished. The 23 patients with complicated fistula were more severely ill, had more sepsis, e.g. intra-abdominal abscess, and were more often treated in the intensive care unit (p less than 0.01) than the 19 with simple fistula. The respective mortality rates were 7/23 and 3/19. All six patients who died of sepsis had complicated fistula. Mortality in the simple fistula group was related to the primary disease. Especially in cases of complicated fistula, further improvements in management of septic complications should be aimed for, to permit success in delayed definitive surgery.

Enteral Nutrition↗