GASTROINTESTINAL FISTULAS - PATHOLOGY AND PROGNOSIS

Background: Gastrointestinal fistulas are a serious complication of ga strointestinal tract surgery: they are often accompanied by high level s of morbidity and mortality. Among other things, some fistula charact eristics (anatomical site, type of tract, time elapsed to fistula appe arance and volume of output) are being considered as of great importan ce. New therapeutic approaches such as somatostatin are nowadays being tested in order to clarify the benefits of its use. Method: A multi-c entre, randomized, controlled and prospective trial was carried out (n = 40, March-December, 1988) to evaluate the effectiveness of total pa renteral nutrition (TPN) Versus TPN + somatostatin in the conservative management of postoperative gastrointestinal fistulas. Since January 1989, wider inclusion criteria have been followed, and all patients (n = 63) who have fulfilled inclusion criteria have been admitted to TPN plus somatostatin treatment. Results: Closure time of fistulas in pat ients receiving TPN + somatostatin was significantly shorter (13.86 +/ - 1.84 versus 20.4 +/- 2.89 days) than in those receiving TPN alone. I n the second phase of the study, more time was needed to obtain comple te closure of fistulas (15.8 days). Conclusion: Somatostatin is a usef ul therapeutic complement in the management of postoperative gastroint estinal fistulas, since it accelerates their spontaneous closure.