Trattamento conservativo delle fistole digestive: nostra esperienza

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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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