Conservative Treatment of Esophageal Postoperative Fistulas

Digestive fistulas have furnished challenging problems for surgeons for many years. In 1971 Goligher wrote on this subject: “The crux of management of digestive fistulas is to decide when to abandon conservative treatment in favour of operation, whilst the latter has a reasonable chance of success, and there are few more difficult decisions in surgery.” Today, 15 years later, many things have changed in surgical technique and postoperative treatment: Dudrick et al. (1972) introduced total parenteral nutrition, and Levy (1974) devised the techniques of low-flow enteral nutrition. With these achievements the mortality of conservative treatment has been lowered (Thomas 1981) and, while the terms of the problem are always the same, surgical or nonsurgical treatment, most authors are in favor of a nonsurgical approach.