[Treatment of patients with external intestinal fistulas and widespread peritoneal adhesions].

OBJECTIVE

To substantiate the safe timing and volume of enterolysis during operative treatment of patients with external small intestinal fistulas against the background of widespread peritoneal adhesive process.

MATERIAL AND

METHODS

Comparative results of treatment of 315 adult patients, divided into 3 groups (60, 74 and 181 patients), depending on the graduation of peritoneal adhesive process, timing of operations and volumes of enterolysis are presented.

RESULTS

The highest postoperative mortality (17 (6.7%) out of 255) and the frequency of complications were characterized by operations performed within 1 month, against the background of widespread adhesive process. After 30 days, more favorable outcomes were observed in patients after complete distal enterolysis. The lowest mortality rate of patients (3 (2.4%) of 127) was observed more than 3 months after the onset of fistulas, after complete distal enterolysis.

CONCLUSION

The presence of widespread peritoneal adhesions worsens the outcomes in patients with external small intestinal fistulas; performing reconstructive operations within more than 3 months from the formation of fistulas and complete distal enterolysis improves treatment results.