Treatment of upper gastrointestinal fistula and leakage with personal stage nutrition support.

AIM: To investigate the feasibility of treatment for upper gastrointestinal fistula and leakage with personal stage nutrition support. METHODS: Forty-three patients with upper gastrointestinal fistula and leakage were randomly divided into two groups. Patients in group A were treated with personal stage nutrition support and patients in group B were treated with total parental nutrition (TPN) in combination with operation. Nutritional states of the candidates were evaluated by detecting albumin (Alb) and pre-Alb. The balance between nutrition and hepatic function was evaluated by measurement of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin (Tbill) before and after operation. At the same time their complications and hospitalized time were surveyed. RESULTS: Personal stage nutrition support improved upper gastrointestinal fistula and leakage. The nutrition state and hepatic function were better in patients who received personal stage nutrition support than in those who did not receive TPN. There was no significant difference in the complication and hospitalized time in the two groups of patients. CONCLUSION: Upper gastrointestinal fistula and leakage can be treated with personal stage nutrition support which is more beneficial for the post-operation recovery and more economic than surgical operation.

[Efficacy of long-term total parenteral nutrition treatment in a case of postoperative fistula of the gastric fundus]. / Considerazioni sull'efficacia del trattamento con NPT di lunga durata in un caso di fistola postchirurgica del fondo gastrico.

The Authors report their experience about an unusual case of gastro fundic fistula arisen after a surgical procedure and successfully treated with long term N.P.T. The Authors describe the modality of the long term treatment, underlining the importance and efficacy of N.P.T. which represents an efficient alternative to surgery.

[Postoperative high digestive-cutaneous fistula. Advantages of nutritional treatment]. / Fistole digestivo-cutanee alte postoperatorie. Vantaggi del trattamento nutrizionale.

Twenty-four patients (18 male and 6 female) with high post-surgery digestive fistulas (8 pancreatic-cutaneous, 7 duodenal-cutaneous, 4 jejunum-cutaneous, 4 ileal-cutaneous, 1 gastric cutaneous) were treated with T.P.N. and/or E.N. between 1980-1983. 17 patients (71%) recovered with spontaneous healing of fistulas in 9-92 (average 39) days. 3 patients underwent a second operation. 3 patients (12.5%) died: 2 for sepsis, 1 for cachexia. A.E. and T.P.N. were able to improve serious catabolic state and to get a better prognosis.

Nutritional support of the hospitalized patient. Part II. Clinical indications.

The first part of this review dealt with the background, methodology and techniques of nutritional support. As a significant proportion of hospitalized patients suffer from various forms of unrecognized and untreated malnutrition, nutritional support is essential for the maintenance of body mass and function until specific treatment is able to influence the course of disease. The following review highlights various medical and surgical conditions in which nutritional support, in particular total parenteral nutrition, has been advocated in adult patients. Nutritional repletion as a therapeutic modality is still in its infancy, and consequently its true role in patient management is still undergoing evaluation.

Home parenteral nutrition: an alternative approach to the management of complicated gastrointestinal fistulas not responding to conventional medical or surgical therapy.

Twelve patients, 9 with enterocutaneous fistulas and 3 with enterovaginal fistulas, were placed on a home parenteral nutrition (HPN) program after conventional inpatient total parenteral nutrition with bowel rest and/or surgical attempts at fistula closure failed. Fistula closure was achieved (in 66%) after from 28 to 400 days on the program. Six closed spontaneously while 2 were closed surgically. Underlying inflammation in the bowel and the persistence of fistula drainage beyond 180 days were indicative of poor prognosis for closure. Number, location, and volume of drainage were not useful prognostic indices. HPN offers an alternative approach in the management of "intractable" gastrointestinal fistulas.

The management of high-output intestinal fistulas.

A high-output gastrointestinal fistula is a surgical catastrophe of the first order of magnitude. Previously associated with an extraordinarily high mortality, the advent of parentaeral nutrition has markedly altered the management of these fistulas. Malnutrition and electrolyte imbalance formerly were the causes of death in the majority of patients. At the present time the mortality rate has decreased from approximately 40-60% to 6-20%, depending on the series. a suggested plan of therapy for high-output gastrointestinal fistulas is outlined. Good local care, sump drainage and nutritional support with or without the use of appropriate antibiotics, depending on the circumstances, are the keystones of management. Radiologic definition of the fistula is of primary importance. Certain criteria by which one may predict fistula closure aare outlined. The emphasis in this chapter is on an attempt at spontaneous closure with parenteral nutrition. In the event that this in not achieved, complete exclusion of the fistula from the gastrointestinal tract, either by excision or by total bypass, is mandatory to achieve satisfactory results. Causes of death remain sepsis and peritonitis related to the fistula, but an occasional patient will succumb to massive bleeding. Catheter-related sepsis and complications of hyperalimentation are largely preventable, and steps to prevent such complications are outlined.