Therapeutic Fistuloscopy: An Alternative Approach in the Management of Postoperative Fistulas

Abstract

Background/Aim: Since the treatment of postoperative fistulas remains a difficult problem, we applied endoscopic treatment in such 14 persistent fistulas. Methods: Fourteen patients presented with postoperative fistulas: 7 patients (low-output group) due to residual cavity after liver hydatid disease surgery and 7 patients (high-output group) after small-bowel resection (n = 3), diverted duodenostomy (n = 1), vertical gastroplasty (n = 1), external pancreatic cyst drainage (n = 1), and transduodenal sphincteroplasty (n = 1). The therapeutic procedures included mechanical removal of silk sutures, necrotic material, and hydatid membranes in the low-output group and fibrin sealing in the high-output group. Results: Fistuloscopy was performed 170–278 days (mean ± SD 198.7 ± 36.7 days) and 18–51 days (mean ± SD 34.0 ± 11.3 days) postoperatively in low- and high-output fistula patients, respectively, when the average daily output was 20–50 (32.8 ± 12.5) ml and 200–1,000 (563.1 ± 319.4) ml, respectively. The low-output group needed only one fistuloscopy session, while the other group required a median number of three sessions plus fibrin sealing, the total amount of fibrin glue used per patient being 2–14 (6.5 ± 4.4) ml. No procedure-related complication occurred. All fistulas except one healed within 10–33 (21.8 ± 7.9) days and 2–17 (9.2 ± 5.1) days in low- and high-output groups, respectively. Conclusions: We believe fistuloscopy to be a useful tool in the management of gastrointestinal fistulas, but more experience should be gained in using this technique.