Faecal (Lower Enterocutaneous) Fistula after Colonic Surgery (Analysis of Its Occurrence & Recurrence)

Hazim, Haytham

	Faecal (Lower Enterocutaneous) Fistula after Colonic Surgery (Analysis of Its Occurrence & Recurrence)
Mustansiriya Medical Journal
Article 1, Volume 7, Issue 2, 2008, Pages 40-45
Author
Haytham Hazim
Abstract
Background: One of the major complications of colonic resections is anastomotic leak that may convert in some cases into permanent faecal fistula, presented with discharge of faecal material from the site of the wound or drain. Objective: To know the incidence of faecal fistula after colonic surgery, and to analyse the associated factors that enhance or reduce its formation and its recurrence. Method: A prospective study of one hundred and thirty seven patients who were undergone colonic surgery in the period from Jan.1996 to Jun.2005. Those patients were followed up for at least one month after the operation of the anastomosis of the colon. The operations were done for different pathologies or lesions. All of the operations in this study were elective with bowel preparation, while 126 patients (92%) had previous colostomy because of an urgent operation in the past. Results: It had been found that the majority of the operations on the colon were closure of the colostomy (92%), especially that due to missile injuries (75.5%). Anastomotic leak appeared in 14 cases (10.2%) of the total operations, ten of them closed spontaneously with conservative treatment and the remaining 4 cases (2.9% of the total) transformed into faecal fistulae. All of these fistulae were in the patients originally injured by high energy missiles. Re-operation for those four patients, after bowel preparation, included excision of the fistula with resection of the affected segment of the colon and reanastomosis. The fistula disappeared in three of them but recurred in the fourth. Conclusions: Although mortality reduced markedly in elective colonic operation, by the modern surgery, faecal fistula still remains a challenge to the surgeons. Bowel preparation, prophylactic antibiotics, good vascularity of the ends of the colon, proper approximation of the ends of the colon without tension, delicate suturing, prevention of perioperative hypotension, and good nutrition of the patient; all are prophylactic measures against formation of the fistula. Once the fistula was formed, then simple suture closure of the fistula alone is not beneficial, preferably resection of the affected segment of the colon is indicated.
Keywords
Anastomotic leak; faecal fistula; colonic surgery

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