A reappraisal of the acquired theory of sacrococcygeal pilonidal sinus and an assessment of its influence on surgical practice
✍ Scribed by D. H. Patey
- Publisher
- John Wiley and Sons
- Year
- 1969
- Tongue
- English
- Weight
- 468 KB
- Volume
- 56
- Category
- Article
- ISSN
- 0007-1323
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✦ Synopsis
We set out to disconnect the afferent loop from the fistula and, after trimming, implant it into the small-bowel stream by end-to-end anastomosis with the efferent loop. Closure of the gastrojejunal defect was then effected, but tube drainage at this point may be an alternative and, if led into the lower jejunum, could be used for feeding. Fig. I illustrates this. Both our cases were technically successful, and we believe that earlier diversion would have led to a lower complication rate in both cases, and possible survival of the second one. We would in future perform an ' en-Y' anastomosis as the primary treatment after initial suture-line breakdown at this point.
Other high-output fistulas have been treated in this way (James, 1969, success being achieved with pancreatic, biliary, and persistent duodenal fistulas. Roux-en-Y anastomosis used as the routine in Polya gastrectomy is reported (Schofield and Denton, 1959) and gives a lower risk of dumping in their series.
SUMhURY
Two cases of gastrojejunocutaneous fistula, as a result of anastomotic failure following Polya gastrectomy, are presented. The literature on the subject is reviewed and a new approach is recommended. It is suggested that early operation, even in the absence of distal obstruction, is the treatment of choice. The operation is described and the rationale for its adoption discussed.
Acknowledgements.-We express our thanks to Mr. R. W. Nevin, whose concept this operation was, for permission to use the first case, and to Professor W. Cranston for permission to use Case 2.