Closure of enteric fistula
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
20G IV+ |
| Monitors |
Standard, 5-lead EKG |
| Primary anesthetic considerations | |
| Preoperative |
Possible SBO, Full stomach considerations |
| Intraoperative | |
| Postoperative |
NG decompression until bowel function returns |
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Enteric Fistulae can occur between the bowel and adjacent tissue including but not limited to: abdominal wall, loops of intestine (enteroenteric, enterocolic), enterovesical, enterovaginal. Surgical repair involves excision of the fistula and separating the organs.
With optimal nonoperative management a fistula may heal spontaneously, the majority within the first 4 weeks after development. Definitive surgical treatment is best achieved with resection of the bowel containing the fistula and anastomosis of healthy normal bowel. The timing of definitive surgery appears to be optimal months after development, if tolerated. Death rates are low after surgery and patients who experience the recurrence of a fistula after initial attempt at closure can ultimately still be cured. [1]
Overview
Indications
Surgical procedure
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | General Endotracheal Anesthesia |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | Malnutrition, dehydration
Consider full stomach. NG decompression until return of bowel function post op |
| Hematologic | |
| Renal | |
| Endocrine | Etiology: can be due to carcinoma |
| Other |
Labs and studies
Operating room setup
Standard setup with 1 good IV
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Standard monitoring
1 good IV
Induction and airway management
Possible SBO and full stomach precautions with Rapid Sequence Intubation to prevent pulmonary aspiration.
Patient may be hypovolemic from lack of nutritional support, consider volume load prior to or after induction.
Positioning
Supine
Lithotomy access to the anus is helpful
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Inpatient
Pain management
IV vs Epidural analgesia
Potential complications
Sepsis
Ileus
PONV
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | 50-200cc | |
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |