Postoperative gastrointestinal fistulas

Almost all postoperative gastrointestinal fistulas result from technical error or error in judgment. Twelve of forty patients with this entity died. Gastric and duodenal fistulas were most serious, small bowel fistulas less serious, and lower ileal and colonic fistulas the least serious. Treatment includes delineating and controlling the fistula by collection and replacement of fluid losses, maintenance of adequate nutrition, control of infection, surgical drainage, and relief of obstruction. The best treatment of gastric and duodenal fistulas is prophylactic since they are hard to treat surgically and have the highest mortality. With small bowel fistulas, once the patient's condition is stable and the fistula shows no tendency to close, then resection of the affected loop has given the best results. The outlook is favorable for lower ileal and colonic fistulas and with watchful waiting most will close with a low mortality.