Early Closure Versus Oral Feeding For External Gastrointestinal Fistulae

Abstract

This work sets out to evaluate the merits and demerits of management of external gastrointestinal fistulas (EGF) with oral diets (OD) and early surgical closure (ESC). It was a controlled randomized prospective study of 53 patients with EGF carried out during a ten-year period at the Jos University Teaching Hospital. Twenty five patients were assigned to OD against 28 patients who were assigned to ESC. Hospital mortality rate for OD was 56% against 25% for ESC (p>0.05). A significant difference in morbidity however was noted especially as intractable diarrhoea was observed in 60% of patients on OD as opposed to 10% in patients in the ESC group. Also significant differences were recorded for severe dehydration which in OD group was 56% against 7% in the ESC group. There was a significantly longer period of hospitalization in the OD group, which was more than 3 days. There was no significant difference in weight gain at six weeks of treatment in the two groups. At six months of treatment, there was fistula closure rate of 63% in the OD group as against 72% in the ESC group which difference was not statistically significant. Both OD and ESC were equally effective in achieving fistula closure at 6 months of treatment but significant number of patients in the OD group suffered from troublesome diarrhoea and dehydration.