Features and choice of surgical strategy in patients with gastrointestinal fistulas

Belokonev V.I.; Pushkin S.Yu.; Kovaleva Z.V.

doi:https://doi.org/10.17116/hirurgia202105158

Belokonev V.I.

Samara State Medical University

Pushkin S.Yu.

Samara State Medical University

Kovaleva Z.V.

Samara State Medical University

Features and choice of surgical strategy in patients with gastrointestinal fistulas

Authors:

Belokonev V.I., Pushkin S.Yu., Kovaleva Z.V.

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Journal: Pirogov Russian Journal of Surgery. 2021;(5): 58‑62

DOI: 10.17116/hirurgia202105158

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Belokonev VI, Pushkin SYu, Kovaleva ZV. Features and choice of surgical strategy in patients with gastrointestinal fistulas. Pirogov Russian Journal of Surgery. 2021;(5):58‑62. (In Russ.)
https://doi.org/10.17116/hirurgia202105158

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

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OBJECTIVE

To evaluate the features and choice of surgical strategy in patients with gastrointestinal fistula based on classification of their types.

MATERIAL AND METHODS

There were 398 patients with gastrointestinal fistula. Fistula type 1 was found in 126 (31.7%) cases, type 2 — 38 (9.6%) cases, type 3 — 73 (18.3%) cases, type 4 — 26 (6.5%) patients, type 5 — 135 (33.9%) cases. One-stage and two-stage treatment was applied in patients with fistula type 1, two-stage treatment only — for fistula type 2. In patients with fistula type 3, treatment strategy depended on timing of fistula formation, its level and amount of intestinal chymus loss. In case of fistula type 4, radical treatment is difficult. However, surgery is safer when adhesions between intestinal loops are not yet dense enough. Indeed, dissection is associated with less risk of their damage. Reconstructive procedures were applied for fistula type 5 depending on its localization.

RESULTS

The causes of gastrointestinal fistula were complications after surgery for acute ileus in 73 patients (17 ones died), blunt abdominal trauma in 81 (8), open abdominal trauma with cold weapons in 39 (6) and firearms in 11 cases (2), mesenteric thrombosis in 33 patients (8), pancreatic necrosis in 25 cases (9), abdominal hernia in 15 cases (4), acute appendicitis in 40 patients (3), colonic diverticulosis in 24 patients (1), urological diseases in 5 cases, colon perforation by a foreign body in 3 cases, colonoscopy in 5 patients, Hirschsprung’s disease in 2 patients, Crohn’s disease in 11 cases (3), colon polyps in 4 patients, intestinal tuberculosis in 1 case (1), small bowel resection for obesity in 1 patient and gynecological diseases in 25 patients (2). Fistulas type 1 and 4 were followed by the highest postoperative mortality since these interventions are associated with the most severe changes in abdominal cavity. Low mortality was observed in patients with fistula type 5, no abdominal inflammation and normalized intestinal passage. The overall mortality in patients with gastrointestinal fistulas was 16.1%.

CONCLUSION

Treatment strategy in patients with gastrointestinal fistula primarily depends on the type of fistula that requires emergency, urgent, delayed or reconstructive surgery. Staged approach in patients with gastrointestinal fistulas can improve treatment outcomes.

Keywords:

intestinal fistula

classification

surgical methods

results

Authors:

Belokonev V.I.

Samara State Medical University

Pushkin S.Yu.

Samara State Medical University

Kovaleva Z.V.

Samara State Medical University

Received:

18.05.2020

Accepted:

29.06.2020

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References:

Manzenreiter L, Spaun G, Weitzendorfer M, Luketina R, Antoniou SA, Wundsam H, Koch OO, Emmanuel K. A proposal for a tailored approach to diverting ostomy for colorectal anastomosis. Minerva Chir. 2018;73(1):29-35. https://doi.org/10.23736/S0026-4733.17.07486-7
Islam MS, Gafur MA, Mahmud AA, Mahiuddin M, Khan SA, Reza E, Rahman MS, Mahmud M, Karim MR, Hoque MM, Salam MA, Khan MH. Clinicopathological Study of Enterocutaneous Fistula in Mymensingh Medical College Hospital. Mymensingh Med J. 2018;27(3):513-519.
Kriger AG. Technical aspects of operations for acute adhesive intestinal obstruction. Pirogov Journal of Surgery. 2017;(4):81-84. (In Russ.). https://doi.org/10.17116/hirurgia2017481-84
Lutsevich OE, Akimov VP, Shirinsky VG, Bichev AA. Adhesive peritoneal disease: a modern view of pathogenesis and treatment. Pirogov Journal of Surgery. 2017;10:100-108. (In Russ.). https://doi.org/10.17116/hirurgia201710100-108
Chernyakhovsky MG. Intestinal fistulas and their treatment. University news. Kiev. 1893;3:1-70. (In Russ.).
Oppel VA. To the basics of surgical treatment of external fecal fistulas. Russian surgical archive. 1907;6:843-868. (In Russ.).
Kaplan AD. On the issue of external intestinal fistulas, on the treatment of an unnatural anus in particular. New surgical archive. 1923;3(3):528-541. (In Russ.).
Kolchenogov PD. External intestinal fistulas and their treatment. M.: Meditsina; 1964. (In Russ.).
Bagnitskaya TN, Uteshev NS. Tactical and technical errors as the cause of external intestinal fistulas. Issues of Surgery. 1976;8:104-108. (In Russ.).
Vantsyan EN. External and internal fistulas in a surgical clinic. M.: Meditsina; 1982. (In Russ.).
Vitsin BA, Blagitko EM. Formed and unformed external intestinal fistulas. Novosibirsk: Nauka; 1983. (In Russ.).
Makarenko TP, Bogdanov AV. Fistulas of the gastrointestinal tract. M.: Meditsina; 1986. (In Russ.).
Kozlov IZ, Androsova TP. Intestinal fistulas. In the book: External and internal fistulas in the surgical clinic. Under the editorship of Vantsyan E.N. M.: Meditsina; 1990. (In Russ.).
Atamanov VV. Purulent peritonitis as a causal factor of intestinal fistulas with severe clinical course. First Moscow international Congress of surgeons. M. 1995. (In Russ.).
Kanshin NN. Immature intestinal fistula and purulent peritonitis. M.: Bioinformatics; 1999. (In Russ.).
Bazaev AV. On the classification of intestinal fistulas. Collection of scientific papers «Selected pages of history and current issues of modern surgery». 2013;3(8):39-41. (In Russ.).
Belokonev VI, Izmailov EP. Clinical variants of fistulas of the gastrointestinal tract and their treatment. Pirogov Journal of Surgery. 2000;12:8-11. (In Russ.).
Koryachkin VA, Strashnov VI. Intensive therapy of threatening conditions. SPb.: Saint-Petersburg medical publishing house; 2002. (In Russ.).
Misky A, Hotouras A, Ribas Y, Ramar S, Bhan C. A systematic literature review on the use of vacuum assisted closure for enterocutaneous fistula. Colorectal Dis. 2016;18(9):846-851. https://doi.org/10.1111/codi.13351
Belokonev VI, Fedorina TA, Kovaleva ZV, et al. Pathogenesis and surgical treatment of postoperative ventral hernias. Samara: GP Perspektiva»; 2005. (In Russ.).
Quinn M, Falconer S, McKee RF. Management of Enterocutaneous Fistula: Outcomes in 276 Patients. World J Surg. 2017;41(10):2502-2511. https://doi.org/10.1007/s00268-017-4063-y
Atema JJ, Mirck B, Van Arum I, Ten Dam SM, Serlie MJ, Boermeester MA. Outcome of acute intestinal failure. Br J Surg. 2016;103(6):701-708. https://doi.org/10.1002/bjs.10094
Vorobyov SA, Levchik EY. Staged treatment of patients with external intestinal fistulas. Issues of Surgery. 2008;167(6):114-118. (In Russ.).
Miranda LE, Miranda AC. Enteroatmospheric fistula management by endoscopic gastrostomy PEG tube. Int Wound J. 2017;14(6):915-917. https://doi.org/10.1111/iwj.12726
de Vries FEE, Atema JJ, van Ruler O, Vaizey CJ, Serlie MJ, Boermeester MA. A Systematic Review and Meta-analysis of Timing and Outcome of Intestinal Failure Surgery in Patients with Enteric Fistula. World J Surg. 2018;42(3):695-706. https://doi.org/10.1007/s00268-017-4224-z