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A prospective study was undertaken to assess the influence of neostigmine, a reversal agent for curarimimetic myorelaxants, on the incidence of postoperative disruption of anastomotic sites. Over a period of one year, 400 patients had surgery, including anastomosis, on the digestive tract for a variety of surgical conditions (Table II). At the end of anaesthesia, 200 patients received doses of atropine and neostigmine, usually 1 mg and 2.5 mg of each, as indicated on clinical basis and neuromuscular stimulation. The other patients did not recieve these drugs and were ventilated till the myorelaxation vanished spontaneously. During the postoperative period of incidence of anastomotic breakdown was assessed by the surgeon, unaware of the use or the omission of neostigmine in his patients. Anastomotic leakage was classified in four groups, namely: proved, absent, likely and unlikely. In this series and according to these clinical criteria, both groups had an incidence of anastomotic breakdown which was not significantly different (Table III). Neostigmine as used in this work does not seem to compromise the normal healing of anastomotic sites on the digestive tract.
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Pancreatic pseudocyst is one of the common complications of acute and chronic pancreatitis and has variable natural history. We present a case of spontaneous resolution of a pancreatic pseudocyst with gastric connection. This case presented a 46-year-old man with a pancreatic pseudocyst resulting from a complication of acute pancreatitis. This resolved spontaneously through the formation of a fistula between the pseudocyst and stomach. The fistula tract was also occluded spontaneously and the patient recovered without any complication or need for surgical treatment. The patient has been good progress at a two year follow up after spontaneous resolution of the fistula.
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In 15 postoperative fistula cases, we performed endoscopic examination (fistuloscopy) and studied the clinical significance. The inside of the fistula was easily observed after irrigation with physiological saline. The drain was extubated in 6 cases in which cavities without abscesses were recognized. In a case of pancreatic fistula, the fistula was temporarily closed using fibrin glue. Re-operation was performed in a case in which recurrence of cancer was recognized by biopsy. On the other hand, in 9 cases in which cavities with abscesses were recognized, foreign bodies, such as suture threads, which were sources of infections were removed. Moreover, the drain was removed to the effective site, and the fistula then irrigated repeatedly. Consequently, with the exception of a death due to cancer and a case complicated by osteomyelitis, the fistula was closed in all cases. Fistuloscopy is a safe and easy technique. In addition, the method, which is less stressful for the patient, is considered to be effective for the examination and treatment of fistulas.
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UNLABELLED: A personal method for the conservative treatment of the postsurgical external digestive fistulas by means of obturation with an elastic balloon of adjustable pressure, used in Surgical Clinic I Craiova in the past 12 years is presented. Initially conceived as an elective method for the treatment of the fistulas exposed in evisceration, the procedure was later applied as a unique method or in association with other conservative procedure in almost all types of fistulas. 122 patients have been treated by means of our method (3 esophageal, 65 gastro-duodenal and gastro-intestinal, 27 intestinal and 27 colo-rectal fistulas), in 53 cases a unique method and in 69 cases as a therapeutically sequences within the conservative treatment of the fistulas. RESULTS: 115 patients (94.2%) have had a fair evolution; we have registered 7 death, which represent a mortality rate of 5.93%. CONCLUSIONS: Our method offers the following advantages: it considerably reduces the losses of digestive liquids through the fistula; it allows early resumption of normal nourishment; it allows early mobilization of the patients; it prevents the occurrence of new fistulas which are caused by decubitus lesions; it is a simple and economic method, which can be applied in any surgical department.