[Intestinal absorption of potassium in the dog with a Thiry-Vella fistula].
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Hypersecretory stomas or fistulas are disabling conditions for the patients and a therapeutic challenge to the surgeons. Octreotide treatment is reported to reduce stoma output and the need for intravenous supplements. Octreotide treatment also reduces social disability due to postprandial hypersecretion causing frequent changes of stoma systems. Two patients with high output stomas and one patient with high output ileocutaneous fistula were treated with the somatostatin analogue octreotide. Reductions in stoma or fistula output from 48 to 62% were observed.
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The excellent results experienced with the use of seromuscular intestinal grafts in certain types of urological plastic operations encouraged us to use it (as a patch) also in the surgical management of vesicovaginal and rectovaginal fistulas. With this method, we treated 4 patients with post-irradiation fistulas who had previously undergone 1 or 2 operations. The seromuscular intestinal graft served as a direct partial wall replacement of the bladder or rectum. At the same time, it also supported the nutrition of the compromised tissues surrounding the fistula. There were no complications with epithelialization of the denuded muscular surface of the seromuscular intestinal graft (patch) facing into the bladder.
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A thiry-Vella isolated intestinal loop was constructed in the guinea pig. The procedure consisted of removal of a 30-cm segment of the jejunem, restoration of intestinal continuity by a jejunojejunostomy, and exteriorization of the segment through stomata sutured to the skin. The procedure was performed on seven guinea pigs of which three survived. The three survivors remained normal in maintenance of hair, feeding, and weight gain over a long period.
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Previous work from our laboratory demonstrated the feasibility of utilizing placental-derived collagen tissue matrix (CTM) as a bowel wall substitute. We reasoned that this technique would also be suitable in managing intestinal fistulae. To test this hypothesis, we created a chronic cecal fistula in rats and randomly managed some with primary repair and others with CTM replacement. Leak rates, mortality, bursting pressures and histologic scores were similar, suggesting that a chronic fistula can be successfully managed with either a CTM or primary repair.