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Endoscopy 2002; 34(8): 632-638
DOI: 10.1055/s-2002-33237
Original Article
© Georg Thieme Verlag Stuttgart · New York

Endoscopic Treatment of Postoperative Fistulas Resistant to Conservative Management Using Biological Fibrin Glue

L.  R.  Rábago1 , N.  Ventosa1 , J.  L.  Castro1 , J.  Marco1 , N.  Herrera1 , F.  Gea1
  • 1Department of Gastroenterology, Hospital Severo Ochoa (Leganés), Madrid, Spain
Further Information

Publication History

Submitted 6 June 2001

Accepted after Revision 22 March 2002

Publication Date:
12 August 2002 (online)

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Background and Study Aims: Postoperative fistulae occur frequently in standard surgical practice, but there is no general agreement on how to treat them. We summarize here our experience with endoscopic treatment.
Patients and Methods: Postoperative digestive fistulae resistant to conservative treatment, in 15 patients, are retrospectively reviewed. Our series included two internal fistulas: (one rectovesical, and one high-output pleuroesophagic), and 13 external fistulas (one low-output gastrocutaneous, two low-output esophagocutaneous, seven low-output enterocutaneous, and three high-output enterocutaneous). After failure of conservative treatment, the fistulas were endoscopically located and 2 - 4 ml of reconstituted fibrin glue, Tissucol 2.0 at 37°C, was injected through a catheter.
Results: The mean age of the patients was 61.2 years (38 - 86), and 60 % were men. Of the fistulas, 26.6 % were of the high-output type. The mean healing time was 16 days (5 - 40), and a mean of 2.5 sessions per patient were required (1 - 5). Complete sealing of fistulas was achieved in 86.6 % of cases; (87.5 % of the low-output and internal fistulas, and 55 % of the high-output fistulas). After follow-up ranging between 2 months and more than 3 years, only one of the sealed fistulas reopened. No complications were encountered. Overall mortality was 13.3 % (two out of 15), but in only one patient was this related to clinical deterioration because of the persistence of the fistula.
Conclusions: We think that conservative treatment should not be prolonged beyond 14 days and that endoscopic treatment should be performed at that stage. Endoscopic sealing treatment achieves a very high success rate, without complications and at a lower cost. It could probably reduce the hospital stay, and avoid some unnecessary surgical interventions. Appropriate multicenter randomized trials are needed to confirm these results.

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L. R. Rábago, M.D.

Sección de Digestivo · Hospital Severo Ochoa Leganés

Avda. Orellana s/n Leganés · Madrid · Spain

Fax: + 34-91-6643797

Email: Irabagot@meditex.es

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