Abstract
Background Gastrointestinal-to-genitourinary fistulas may occur secondary to obstetric complications,
radiation therapy, cancer without radiation, inflammatory bowel disease, or previous
surgery. Flap reconstruction is useful for complex cases refractory to standard techniques,
separating the fistula tracts to aid healing. The purpose of this study was to investigate
outcomes and risk factors for complications in flap reconstruction of fistulas from
several different etiologies performed over a 20-year period.
Methods All patients who underwent flap reconstruction between January 1995 and December
2014 were reviewed. Patient demographics, prior treatment failures, surgical indications,
and comorbidities were obtained. Operative and postoperative data were collected,
including flap type, length of stay, early and late complications, recurrences, and
follow-up time. Operative success was defined as definitive treatment of the fistula
without recurrence within 6 months.
Results There were 59 patients who underwent 66 reconstructions. The overall complication
rate was 59.1%. Complications included infection (21%), dehiscence (17%), and partial
flap loss (1.5%). Operative success rate was 51.5%. Smoking history (p = 0.021) and body mass index (BMI) > 35 (p = 0.003) were significantly associated with increased likelihood of postoperative
complications following flap reconstruction in these patients. Additionally, fistulas
due to cancer resections had a higher likelihood of postoperative complications compared
with fistulas due to bowel disease or obstetric complications (p = 0.04).
Conclusion Flap reconstruction can be successfully used for complex or refractory gastrointestinal-to-genitourinary
fistulas. However, considerable complication and recurrence rates were found in this
population. Patients with a BMI > 35 and a history of smoking were at greatest risk
in this cohort of experiencing postoperative complications.
Keywords
fistula - flap reconstruction - microsurgery
