What is an intestinal fistula?
An intestinal fistula is an abnormal channel through which intestinal contents reach the skin or other organs.
Fistulas may develop as a result of:
- postoperative complications
- Crohn's disease
- diverticular disease
- tumors
- injuries
- radiation damage
- inflammatory processes
The operation aims to eliminate the cause of the fistula and restore normal bowel anatomy.
Our approach
At MSI, intestinal fistulas are treated in stages in line with modern *ECCO, ASCRS, and ESCP* guidelines and the principles of reconstructive abdominal surgery.
Before surgery, a comprehensive examination is carried out, which may include:
- computed tomography
- CT with contrast through the fistula (fistulography) when indicated
- MRI
- colonoscopy or enteroscopy
- laboratory tests
- assessment of nutritional status
Before surgery, infection is always treated, protein-energy malnutrition is corrected, and the patient's general condition is stabilized.
*When technically feasible, we aim to perform operations laparoscopically.* However, complex postoperative fistulas or extensive adhesions often require open surgery.
Postoperative treatment follows the principles of *ERAS (Enhanced Recovery After Surgery)*.
When is surgery needed?
Intestinal fistula closure is performed for:
- postoperative intestinal fistulas
- enterocutaneous fistulas
- enteroenteric fistulas
- enterocolic fistulas
- enterovesical fistulas
- enterovaginal fistulas
- fistulas in Crohn's disease
- ineffective conservative treatment
Indications for surgery
Surgery is recommended for:
- fistulas that have not closed on their own
- high output of intestinal contents
- recurrent infections
- strictures or obstruction
- the presence of a tumor
- cases where conservative treatment is impossible
How is the operation performed?
The procedure is performed under general anesthesia.
After a thorough exploration of the abdominal organs, the fistula tract is dissected and its cause is identified.
Depending on the clinical situation, the following may be performed:
- excision of the fistula
- suture repair of the bowel defect
- segmental resection of the small or large intestine
- elimination of associated strictures
- reconstruction of the intestinal anastomosis
In complex cases, a temporary protective stoma may be needed.
Advantages of modern surgical treatment
- Individual choice of the optimal extent of surgery
- Maximum preservation of bowel function
- Elimination of the cause of the fistula
- Performed laparoscopically whenever possible
- Lower risk of the fistula recurring
- Restoration of the patient's quality of life
Recovery after surgery
Postoperative treatment follows *ERAS* principles.
Special attention is paid to:
- monitoring healing of the anastomosis
- nutritional support
- prevention of infectious complications
- early mobilization of the patient
In Crohn's disease, further treatment is carried out together with a gastroenterologist.
Our advantages
- Specialization in reconstructive bowel surgery
- Extensive experience in treating complex postoperative fistulas
- A commitment to laparoscopic surgery whenever possible
- Comprehensive preoperative preparation
- A multidisciplinary approach
- Adherence to ECCO, ESCP, and ASCRS international guidelines
- Enhanced recovery program (ERAS)
Frequently Asked Questions
No. Some fistulas can close after conservative treatment. Surgery is performed when spontaneous healing is unlikely or complications have already developed.
Postoperative fistulas often require a period of preparation. Inflammation must be eliminated, the patient's nutritional status improved, and firm tissue allowed to form, which significantly increases the chances of successful fistula closure.
Yes. When indicated and technically feasible, we aim to perform the procedure laparoscopically. Extensive adhesions or multiple fistulas may require open surgery.
No. In most cases, bowel continuity can be restored without a stoma. A temporary stoma is created only when necessary for safe healing of the bowel.
Yes. The risk of recurrence depends on the underlying disease, especially Crohn's disease, as well as on the condition of the tissues and the severity of the previous inflammation. That is why careful preparation for surgery and follow-up are important.