Trattamento conservativo delle fistole digestive: nostra esperienza


Maurizio Castriconi, Giuseppe Romagnuolo, Maria Elena Giuliano, Giovanni Bartone, Francesco Chianese, Mauro Natale Domenico Maglio, Carlo Molino, Patrizio Festa, Enzo Saverio Zito, Guido De Sena

Ann. Ital. Chir., 2005; 76: 523-527

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OBJECTIVE: The authors, thanks to experience obtained in an Unit for the treatment of digestive fistulas, discuss the possibility
of a conservative treatment for the anastomotic fistulas.
MATERIAL AND METHODS: From 2000 to 2003 were treated thirty-five patients with post-anastomotic gastroenteric fistulas
marked according to their localization, way end output (51.5% high, 42.8% moderate and 5.7% low). The treatment
is based on an aspiration system, sometimes integrated with an irrigation system. A semi-permeable barrier was
created over the fistula by vacuum packing a synthetic, hydrophobic, polymer covered with a self-adherent surgical sheet.
This system create a vacuum chamber equipped with a subathmospheric pressures between 262.2 and 337.5 mmHg
(350-450 mmbar), integrated with a continuous irrigation using antibiotic solutions or 3% lactic acid.
RESULTS: The AA. obtained the resolution in 30 patients (85.7%), 3 patients needs the surgery (8.6%), 2 died, one
for sepsis and the other one for malnutrition. The mean time for the closure was 45 days (from 20 to 90). A part of
digestive external fistulas goes to spontaneous resolution so comes the idea that the creation of particular condition is the
basis of their closure.


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