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A fistula is a channel that opens between two parts of the body. For example, some fistulas connect the stomach to a blood vessel or an artery to a vein. The most common fistula treatment often depends on the severity of the problem. If the fistula is small, it might spontaneously close on its own, and physicians will simply monitor the situation to ensure that it does not worsen. If the fistula is severe, the most common treatment is a surgical procedure — such as a steton stitch, a fistulotomy, an endorectal flap procedure or catheter embolization — paired with antibiotics to prevent infection.
A steton stitch procedure is one common surgical treatment for a fistula. In this procedure, a surgical cord is looped through the fistula. This allows the fistula to drain, so pus and other fluids do not build up in the fistula and impede healing. A steton procedure can be a complete treatment for a fistula, or it can be a way to clean out the fistula before surgery.
Another surgical fistula treatment is a fistulotomy. In this procedure, the fistula tract is removed, and the barrier between the two channels that it connected is rebuilt. If the fistula was large, tissue from another part of the body might be grafted onto the fistula opening to close it.
An endorectal flap procedure is a common fistula treatment for a gastric fistula. This procedure involves pulling healthy tissue over the internal side of the fistula to close it. This prevents material from the digestive system spreading into the bloodstream and causing infection.
An arteriovenous fistula, or a connection between an artery and a vein, is often treated with catheter embolization. In this procedure, a doctor uses imaging techniques such as X-rays to navigate a catheter to the side of the fistula. After the catheter is there, a small stent is placed to reroute the flow of blood and close the fistula.
In some cases, abscesses can develop at the site of a fistula, caused by accumulation of pus and other fluids. This can complicate fistula treatment, because the abscess usually needs to be drained before surgery. Antibiotics and steton stitch procedures can help prevent the development of abscesses.
Fistulas can be the result of trauma, including sugery. Weight-loss surgery, such as a gastric bypass, has a chance of causing a gastric fistula. Infections or chronic inflammation caused by diseases such as Crohn's disease can also wear away the lining of the organs, causing fistulas.
Fistula treatment is not always necessary, but fistulas should be constantly monitored because they can be dangerous. Arteriovenous fistulas can lead to blood clots and heart failure. Fistulas that open the bowel can causes sepsis, a severe infection that can lead to death if it is not immediately treated.