Das Management der Milchgangsfistel: eine Evaluation 13-jähriger Erfahrung mit Fistelexstirpation und primärem Wundverschluss

OBJECTIVE: Mammary duct fistula is a rare and poorly understood condition causing long-term distress to the affected patients. They suffer from pain, recurrent infections and poor cosmetic results after repeated operations. The preferred surgical approaches are uncertain and management is not yet standardised. In this article we give an overview of the literature and present our experiences of 13 years of fistulectomy with primary closure under antibiotic cover. MATERIAL AND METHODS: A retrospective analysis of the case notes of patients diagnosed with mammary duct fistula from 7/1993 until 10/2007 was undertaken. The patients were interviewed by telephone using a questionnaire. 110 patients were treated, 78 patients could be reached in the follow-up. RESULTS: The mean follow-up was 31 months (range 4 - 175 months). The mean age of the patients was 40.5 years (range 20 - 65 years). The mean duration of patients' complaints prior to operation was 39 months (range 0 - 27 years). 46 % of patients had undergone previous operations. In 12 % the fistula recurred. The mean values indicating perceived pain were high and reached 6.6 points on a visual analogue scale (range of scale 0 - 10). CONCLUSION: The long duration of complaints until a definite operation is performed illustrates the fact that proper management of mammary duct fistulas is still not sufficiently widespread. The affected women suffer considerable pain. An operative approach with a fistulectomy and primary closure under antibiotic cover offers good results and should be carried out in specialised centres.