Observational study reveals that conservative management leads to better outcomes in gastrointestinal fistulae, suggesting effective strategies for treatment.
Background: Gastrointestinal (GI) fistulae represent a complex clinical challenge, often associated with significant morbidity, mortality, and prolonged hospitalization. Their management remains controversial, with both conservative and surgical approaches being utilized depending on patient condition, fistula characteristics, and associated complications. Objective: To analyze the outcomes of 100 cases of gastrointestinal fistulae, comparing conservative versus surgical management. Methods: A prospective and retrospective observational study of 100 patients with GI fistulae was conducted at the Department of General Surgery, Dinajpur Medical College Hospital, Different Private Hospitals in Dinajpur, Bangladesh between October-2020-September 2024. Patients were grouped based on management: Group A (conservative management, n=60) and Group B (surgical management, n=40). Data on demographics, etiology, fistula type, treatment outcomes, complications, and mortality were analyzed. Results: The mean age was 43.5 years, with a male-to-female ratio of 1.7:1. The most common cause was postoperative fistula (65%), followed by inflammatory bowel disease (15%), malignancy (10%), and trauma (10%). Spontaneous closure occurred in 70% of conservatively managed patients versus 25% in the surgical group prior to reoperation. Overall mortality was 18%, higher in the surgical group (25%) compared to the conservative group (13.3%). Duration of hospital stay was significantly longer in surgical cases (32 ± 8 days) compared to conservative cases (21 ± 6 days). Nutritional support and sepsis control were crucial predictors of outcome. Conclusion: Conservative management remains the cornerstone of gastrointestinal fistula care, with surgery reserved for complicated or refractory cases. Early nutritional support, infection control, and individualized treatment planning improve survival and fistula closure rates.
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Chakrabarty et al. (2024) studied this question.