ABDOMINAL POSTOPERATIVE FISTULA - HOW TO AVOID, HOW TO TREST tbanasiewicz@op.pl

 

ABDOMINAL POSTOPERATIVE FISTULA - HOW TO AVOID, HOW TO TREST

1

 

 

 

 

Poland

Oral or Poster

Postoperative fistula after GI tract surgery remains as a important clinical problem. The progressive prevention (including prehabilitation) early detection anf treatment are crucial to reduce the risk of the fistula and mortlality

450 patients after lower GI tract surgery (IBD, cancer, other indications were analyzed). In 250 the operation was done as the next step of treatment, in 117 cases after prevoius complications (165 patients with stoma, 58 with active fistula). In 250 patients prehabilitation program was included. All patients were controlled for anastomotic leak, SSI, other complications (in 205 with telemedical application)

In analyzed group 49 of anastomic leaks were detected, mainly in firts 7 days after surgery. In 27 cases leak was localized in pelvis. In patients diagnosis was done based on the CT, biochemistty and early endoscopy. In all possible cases (22 patients) endovacuum was used as a primary treatment, in some of them without stoma formation. In 22 cases reoperation was necessary, in 7 multiple intervention, including open abdomen vac therapy, was necessary. Mortality in all group was 7 patients, 5 of them with postoperative fustula. In endovacuum group the healing rate was 72%. The mortality and severe complications ware statustucally less frequent in prehabilitation group.

Effective prehabilitation is crucial in GI tract surgery. Risk of anastomotic leak, especially in complicated patients (multiple operations, active fistula) remains high. Eraly detection and mininal invasive treaymwnt, including endovacuum) csn be the key to success. In Open abdomen vac therapy primary fascial closure should be the target.