Novel Approach for Enterocutaneous Fistula Treatment with the Use of Viable Cryopreserved Placental Membrane.

Frederick Nichols,Aaron Overly

doi:10.1155/2016/8797691

Abstract

Enterocutaneous fistulas (ECF) are a difficult and costly surgical complication to manage. The standard treatment of nil per os (NPO) and total paraenteral nutrition (TPN) is not well tolerated by patients. TPN is also known for complications associated with long term central venous catheterization and for high cost of prolonged hospital stay. We present two low output ECF cases successfully treated with viable cryopreserved placental membrane (vCPM) placed into the fistula tracts. One patient is a 59-year-old male with a low output ECF from a jejunostomy tube site four weeks after the surgery. The second patient is an 87-year-old male with a low output ECF following a small bowel resection secondary to a strangulated inguinal hernia. He was evaluated on day 41 after surgery. NPO and TPN for several weeks did not resolute the ECF. The fistulae were closed postoperatively in both patients with zero output on the same day after one vCPM application. On day 3 postoperatively both patients were started on clear liquid diets and subsequently advanced to regular diets. The ECF have remained resolved for over 2 months. The use of vCPM is a novel promising approach for treatment of ECF.

Highlights

The treatment of Enterocutaneous fistulas (ECF) remains a challenging surgical problem
Placental membranes have anti-inflammatory, antimicrobial, antifibrotic, and angiogenic properties [17, 20, 21]. These properties of placental membranes attributed to their unique composition: a collagen-rich extracellular matrix, growth factors, and endogenous viable cells, including epithelial cells, fibroblasts, and mesenchymal stem cells [17,18,19]
A viable cryopreserved placental membrane (Osiris Therapeutics, Inc.), is a commercial product that retains all components of placental tissue in their native state [24]

Summary

Introduction

The treatment of ECF remains a challenging surgical problem. ECF result in malnutrition, sepsis, electrolyte, and fluid balance abnormalities, which are associated with considerable morbidity and mortality. The chorionic membrane is composed of the mesenchymal layer, which like the amniotic membrane contains fibroblasts and MSCs in a collagen-rich matrix, and the chorionic trophoblast [17,18,19]. Majority of commercial methods involve dehydration resulting in products that retain placental matrix and growth factors, but destroy tissue viable cells [20]. A use of a dehydrated amniotic allograft for surgical treatment of a vesicovaginal fistula has been reported [25]. The use as a patch is the most common for the placental membranes; for ECF with a narrow aperture an application of a dehydrated sheet of the amniotic membrane in the fistula is challenging

Presentation of Cases

Findings

Discussion