Postoperative fistulas of the small intestine: Therapeutic principles

Postoperative fistulas of the small intestine are a daunting and distressing complication in abdominal surgery. On the basis of a series of 54 observations and a review of the literature, the writers evaluated various factors, concluding that the following have a significantly unfavorable effect on prognosis: existence of an intraperitoneal septic focus, diseased fistulized intestine, a fistula exposed in an evisceration, complex fistulas, and the patient's age. The aim of treatment is to find solutions to 3 problems: sometimes that of peritonitis, frequently that of the loss of parietal substance, and invariably that of the fistula. If early surgery must be carried out, it will be regarded as a rescue operation, involving notably an enterostomy and sometimes a laparotomy. Otherwise, surgery will be deferred as long as possible (beyond the second month) and will be based on a single‐stage operation (resection‐anastomosis) or, more frequently, phased operations, precedence being given to treatment of the intestinal fistula rather than that of parietal dehiscence.