Clinical Analysis of Post-Operative Enterocutaneous Fistulas

ABSTRACT

Despite recent advances in nutritional support, patient monitoring, and surgical intensive care, as well as some improvement in surgical techniques, post-operative fistulas have been regarded as one of the most serious complications in abdominal surgery. The present study was undertaken to evaluate the effectiveness of treatment with total parenteral nutrition (TPN) alone (group A, n=26) or with TPN combined with octreotide, a long-acting analog of somatostatin (group B, n=20) in post-operative enterocutaneous fistulas. In group A, we treated 2 biliary, 10 pancreatic and 14 intestinal cutaneous fistulas with total parenteral nutrition. In group B, we treated 6 biliary, 8 pancreatic and 6 intestinal cutaneous fistulas with octreotide. The results obtained from the analysis are as follows 1) The spontaneous closure of the fistulas was 69.2% in group A and 75.0% in group B. 2) The mean interval of time to achieve the healing of the fistula was 30.44 days in group A and 14.53 days in group B. 3) The mean interval of time to achieve a fistula output reduction of 50% was 6.44 days in group A and 2.44 days in group B. 4) In patients with low-output fistulas, the spontaneous closure of the fistula was 81.8% in group A and 80.0% in group B. In patients with high-output fistulas, the spontaneous closure of the fistula was 60.0% in group A and 73.3% in group B. 5) In patients with low albumin ( or = 3.0 g/dl), the spontaneous closure of the fistula was 80.0% in group A and 85.7% in group B. 6) In patients with an abdominal abscess, the spontaneous closure of the fistula was 40.0% in group A and 40.0% in group B. In patients without an abdominal abscess, the spontaneous closure of the fistula was 87.5% in group A and 86.7% in group B. 7) As compared with TPN, the spontaneous closure of the fistulas treated with octreotide was increased in the gastroduodenum and the external biliary system, was similar in the small bowel and the pancreas, but was decreased in the colon. We conclude that octreotide is a useful therapeutic complement in the conservative treatment of selected patients with post-operative cutaneous fistulas, especially fistulas in the external biliary system and the gastroduodenum.