Own modification of the surgical treatment of aorto-duodenal fistulas in comparison with other operative methods

Background. This paper is a comparison of surgical treatment of secondary enteroaortal fistulas using own modification of surgical technique. Material and methods. There were analysed 18 patients treated for secondary enteroaortal fistulas as a complication of the vascular prosthesis implantation. Patients were operated and the dracon prosthesis was changed to arterial homograft, which is more resistant to infections or using subclavio-femoral bypasses. Removal of intestinal fistula included resection of duodenum and gastroenterotomy or duodenorrhaphy. The own modification of duodenal fistula provision relies on duodenorraphy and protection of that area with pediculated flap of gastrocolic omentum conducted retrocolically in retroperitonal space. Results. The resection of duodenum was performed in 5 patients. In 9 patients duodenorraphy with two layer suture was performed. In these cases transperitoneal flap of omentum was fixed additionally in place of double layer suture of duodenum. In 4 patients retroperitoneal retrocolical omentoplasty was performed, the penduculated flap of gastrocolic omentum was conducted retrocolically and retroperitoneally. The fistula in 15 patients resulted from dehiscence of upper part of anastomosis of vascular prosthesis with aorta, in 2 cases decubitus ulcer evoked by graft hanged into fistula, in 1 patient fistula was a result of prosthesis. In 1 patient both mechanisms of fistula forming were observed. 6 patients died during the postoperative period. No death was observed retrocolic omentoplasty. Conclusion. Secondary enteroaortal fistula is the most serious complication following infection of vascular prosthesis, with high risk of death rate regardless of using different operative methods.