Postoperative Enterocutaneous Fistula Research Articles

836 Aetiology and Management Outcomes of Adult Mechanical Bowel Obstruction in Nigeria: A Systematic Review and Meta-analysis

Abstract Aim Adult mechanical bowel obstruction (AMBO) has been previously reported to be majorly caused by hernias in developing countries. In Nigeria, however, there has been a recent change in pattern with adhesions now being the leading cause. The changing pattern of the causes, clinical features, mode of management and factors influencing the outcome of adult patients managed for bowel obstruction in Nigeria necessitated this review. Method Relevant keywords relating to AMBO were used to conduct a search on PubMed, Google Scholar and AJOL. The search returned 452 articles which were subjected to title, abstract and full text screening, according to the inclusion and exclusion criteria. 10 articles met the inclusion criteria and were included in the final qualitative synthesis. Results The total sample size across the 10 studies was 1033. Adhesions, hernias and intra-abdominal tumours, which are responsible for 46.25%, 26.31% and 12.23% of cases respectively, were the major causes of AMBO. 65.6% of cases were managed operatively and 34.4% were managed conservatively. The meta-analysis revealed high morbidity and mortality rates of 31% (95% CI:17, 44) and 11% (95% CI: 6, 15), respectively, among adult patients managed for mechanical bowel obstruction in Nigeria. Conclusions Adhesion, which results majorly from appendicectomy is the most common cause of AMBO in Nigeria. This is unlike former reports where hernia was the most common cause. Morbidity results majorly from wound infection, recurrent adhesions and post-operative enterocutaneous fistula. The mortality rate is similar to reports from various West African studies, and it is significantly influenced by surgical intervention time.

SP8.3 Aetiology and Management Outcomes of Adult Mechanical Bowel Obstruction in Nigeria: A Systematic Review and Meta-analysis

Abstract Aim Adult mechanical bowel obstruction (AMBO) has been previously reported to be majorly caused by hernias in developing countries. In Nigeria, however, there has been a recent change in pattern with adhesions now being the leading cause. The changing pattern of the causes, clinical features, mode of management and factors influencing the outcome of adult patients managed for bowel obstruction in Nigeria necessitated this review. Method Relevant keywords relating to AMBO were used to conduct a search on PubMed, Google Scholar and AJOL. 452 articles were subjected to title, abstract and full text screening, according to the inclusion and exclusion criteria. 10 articles met the inclusion criteria and were included in the final qualitative synthesis. Results The total sample size across the 10 studies was 1033. Adhesions, hernias and intra-abdominal tumours, responsible for 46.25%, 26.31% and 12.23% of cases, respectively, were the major causes of AMBO. 65.6% of cases were managed operatively and 34.4% were managed conservatively. The meta-analysis revealed high morbidity and mortality rates of 31% (95% CI: 17, 44) and 11% (95% CI: 6, 15), respectively, among adult patients managed for mechanical bowel obstruction in Nigeria. Conclusions Adhesion, which results majorly from appendicectomy is the most common cause of AMBO in Nigeria. This is unlike former reports where hernia was the most common cause. Morbidity results majorly from wound infection, recurrent adhesions and post-operative enterocutaneous fistula. The mortality rate is similar to reports from various West African studies and it is significantly influenced by surgical intervention time.

Endoscopic closure of a postoperative enterocutaneous fistula using an over-the-scope-clip (OTSC) system

Endoscopic closure of a postoperative enterocutaneous fistula using an over-the-scope-clip (OTSC) system

Therapeutic Options in Postoperative Enterocutaneous Fistula-A Retrospective Case Series.

Objectives: The aim of the study was to present the results obtained in our experiment regarding the management of postoperative enterocutaneous fistulas (PECF). Materials and Methods: We conducted a retrospective study on 64 PECF registered after 2030 abdominal surgeries (1525 digestive tract surgeries and 505 extra-digestive ones) over a period of 7 years (1st of January 2014–31th of December 2020) in the 1st and 2nd Surgery Clinics, Clinical County Emergency Hospital of Craiova, Romania. The group included 41 men (64.06%) and 23 women (35.34%), aged between 21–94 years. Of the cases, 71.85% occurred in elderly patients over 65 years old. Spontaneous fistulas in Crohn’s disease, intestinal diverticulosis, or specific inflammatory bowel disease were excluded. Results: The overall incidence of 3.15% varied according to the surgery type: 6.22% after gastroduodenal surgery, 1.78% after enterectomies, 4.30% after colorectal surgery, 4.28% after bilio-digestive anastomoses, and 0.39% after extra-digestive surgery. We recorded a 70.31% fistula closure rate, 78.94% after exclusive conservative treatment and 57.61% after surgery; morbidity was 79.68%, mortality was 29.68%. Conclusion: PECF management requires a multidisciplinary approach and is carried out according to an algorithm underlying well-established objectives and priorities. Conservative treatment including resuscitation, sepsis control, output control, skin protection, and nutritional support is the first line treatment; surgery is reserved for complications or permanent repair of fistulas that do not close under conservative treatment. The therapeutic strategy is adapted to topography, morphological characteristics and fistula output, age, general condition, and response to therapy.

Incisional hernia repair with a slowly absorbable P4HB mesh: what happens after the mesh disappears? A retrospective longitudinal clinical study.

To analyze the incisional hernia recurrence rate at a long-term follow-up using a biosynthetic long-term absorbable mesh in patients with a higher risk of surgical infection in a contaminated surgical field. This was a retrospective multicentric study. All patients undergoing incisional hernia repair between 2016 and 2018 at 6 participating university centers were included. Patients were classified according to the Ventral Hernia Working Group (VHWG). All consecutive patients who underwent abdominal wall repair using biosynthetic long-term absorbable mesh (Phasix®) in contaminated fields (grade 3 and 4 of the VHWG classification) were included. Patients were followed-up until September 2021. Preoperative, operative, and postoperative data were collected. All patients' surgical site infections (SSIs) and surgical site occurrences (SSOs) were recorded. The primary outcome of interest was the clinical incisional hernia recurrence rate. One hundred and eight patients were included: 77 with VHWG grade 3 (71.3%) and 31 with VHWG grade 4 (28.7%). Median time follow-up was 41months [24; 63]. Twenty-four patients had clinical recurrence during the follow-up (22.2%). The SSI and SSO rates were 24.1% and 36.1%, respectively. On multivariate analysis, risk factors for incisional hernia recurrence were previous recurrence, mesh location, and postoperative enterocutaneous fistula. At the 3year follow-up, the recurrence rate with a biosynthetic absorbable mesh (Phasix®) for incisional hernia repair in high-risk patients (VHWG grade 3 and 4) seemed to be suitable (22.2%). Most complications occurred in the first year, and SSI and SSO rates were low despite high-risk VHWG grading.

Postoperative Enterocutaneous Fistula: A Severe and Desperate Complication in a Disadvantaged Surgical Setting

Purpose: Digestive or gastrointestinal fistula is one of the most feared postoperative complication along with dehiscence and infection. The aim of this study was to determine the etiological, clinical and therapeutic aspects of enterocutaneous fistulas in a disadvantaged surgical setting. Methods: This was a retrospective study covering a period of three years (January 2018 to December 2020) including records of patients managed for postoperative enterocutaneous fistula in the general surgery department of the Ignace DEEN national hospital in Conakry (Guinea). Results: During the three years of study, we compiled 69 records of patients with postoperative enterocutaneous fistulas, representing 14.68% of all postoperative abdominal complications registered in the department (n=468). The mean age of the patients was 29.61±17.32 years. In this series, 53 patients (76.81%) were initially operated in private health facilities and then referred to our department after the occurrence of the fistula. The most frequent indications for initial surgery were typhoid ileal perforation (37.68%) followed by appendicitis (26.09%) and sigmoid colon volvulus (15.94%). Spontaneous closure of the fistula was obtained in 41 patients (59.42%) with a mean time of 23 days. We noted 18 deaths (26.09%). Conclusion: Postoperative enterocutaneous fistula is a severe complication whose management in our environment is difficult and desperate for both patient and surgeon.

Postoperative enterocutaneous fistulas: Management outcomes in 23 consecutive patients

BackgroundAbout 75%–85% of enterocutaneous fistulas are postoperative. Such fistulas are still disastrous and frustrating complication for surgeon and the patient and their management remains one of major challenge and dilemma in general surgical practice. Strict adherence to treatment guideline according to SOWATS protocol could results in better outcomes. The objectiveof this study was to assess the management outcomes of 23 patients with postoperative enterocutaneous fistulas. MethodsA total of 23 consecutive patients with postoperative enterocutaneous fistulas during the period of study were included. These fistulas were classified anatomically and physiologically. The predictive factors for spontaneous closure, management outcomes and mortality rate factors for were studied. ResultsOverall Closure of the fistulas was accomplished in 16 patients (69.6%). Spontaneous closure after successful conservative management was seen in 4 patients (17.4%). The average time between fistula development and spontaneous closure was 32 days (range12–66 days). Of 19 patients underwent corrective surgery, closure was achieved in 12 patients (52.2%), thus the surgical success rate was 63.2%. Surgical intervention was performed after an average period of 28 days (range 18–42 days) from diagnosis of the fistula. Five patients with high output (21.7%) died because of sepsis, severe malnutrition and organ failure. Conclusionadherence to standardized protocol and multidisciplinary approach of patients with enterocutaneous fistulas could results in good outcomes. A reasonable period of conservative treatment is always required to optimize patient's general conditions and for spontaneous closure of fistula. Operative correction is usually required for proximal high output and complex fistulas. The complexity of the fistulas, sepsis, high output effluent and comorbidities are the main factors affecting healing rates and fistula related mortality.

Outcome and management of postoperative enterocutaneous fistula

Background: Approximately 75% of enterocutaneous fistula (ECF) occur following surgery. Due to the high morbidity and mortality associated with ECF, prompt and effective treatment is important. This study was conducted to study the outcome and management of patients with enterocutaneous fistula.Methods: Total 40 patients developing the enterocutaneous fistula following surgery were included. All patients were treated either conservatively or operatively by various means and varying period of time. Treatment was focused on the correction of dehydration, controlling sepsis, management of electrolyte imbalance and nutritional support.Results: Overall 40 patients were included in this observational study, comprising 26 were males and 14 were females. About 97.5% of ECF were postoperative. Ileum was found to be the most common site of ECF. Also, 42.5% of fistulas were high output and 57.5% were low output. Serum albumin levels correlated significantly with fistula healing and mortality. Surgical intervention was required in 37.5% of patients.Conclusions: Conservative management with emphasis on improvement of nutrition, control of sepsis, management of fluid and electrolyte balance and control of fistula output is first line of management. Operative intervention must be done in selectively after cases after aggressive and targeted measures for improvement of nutritional status and control of infection.

Gastrointestinal Stomas and Fistulas: What is Lost and What to Do?

Abnormal connections between gastrointestinal tract (GIT) and skin are called enterocutaneous fistulas (ECFs). Presence of ECF is associated with significant morbidity and mortality. A stoma refers to a surgically created opening in the abdomen to divert feces or urine to the outside of the body, to compensate for partial or complete loss of bowel function. Gastrointestinal (GI) stomas and postoperative ECFs present a unique challenge to the intensivist due to development of malnutrition, dehydration, and sepsis leading to high morbidity and mortality. This review focuses on the basic concepts about the type of fistula and stomas, their indications and complications, and management. Principles of clinical management include replacement of fluid and electrolyte losses, control of sepsis along with reducing fistula output, prevention of malnutrition and psychological support, and skin care.How to cite this article: Pande RK, Gupta A. Gastrointestinal Stomas and Fistulas: What is Lost and What to Do? Indian J Crit Care Med 2020;24(Suppl 4):S175–S178.

Frequency of spontaneous closure of post-operative enterocutaneous fistula.

Objectives: To determine the frequency of spontaneous closure of post-operative enterocutaneous fistula at a tertiary care hospital. Study Design: Descriptive Case Series. Setting: Department of General Surgery Unit-I, Nishtar Medical University/ Hospital, Multan. Period: Nine months 1/4/2018 to 31/12/2018. Material & Methods: Non-probability consecutive sampling. Results: From 80 patients, 34 (42.5%) were male and 46 (57.5%) were female. Mean age of our patients was 40.31 ± 10.58 years. Most of our patients i.e. 55 (68.8%) belonged to poor families. Mean body mass index of our patients was 24.67 ± 3.39 kg/m2 and obesity was present in only 14 (17.5%) patients. Initial surgery was elective in 53 (66.2%) and emergency surgery in 27 (33.8%) patients. Site of origin of ECFs was gastric in 17 (21.3%), duodenum in 22 (27.5%), Jejunum in 14 (17.4%), Ilium was involved in 17(21.3%) and colorectal in 10(12.5%). Mean disease duration was 3.21 ± 2.09 weeks and mean duration of surgery was noted to be 4.71 ± 2.13 hours and 73.8% underwent surgical procedure for up to 5 hours. Mean hospital stay was noted to be 13.58 ± 7.41 days while 73.8% stayed in hospital for more than 7 days. Spontaneous closure of post-operative enterocutaneous fistula was noted in 25 (31.3%) of our patients. Conclusion: Spontaneous closure of post-operative enterocutaneous fistula without any surgical intervention is quite common.

Vacuum assisted closure system in the management of postoperative complex enterocutaneous fistulae: Postoperative Cohort Study‎

Background: There is controversy in the use of vacuum assisted closure therapy (VAC) in management of enterocutaneous fistula (ECF). Due to the increased risk of new fistula formation, its use was contraindicated, but then several studies reported successful closure, fistula effluent control and healing of excoriated skin by keeping it dry. Objectives: The aim of this study is to evaluate the efficacy of VAC in treatment of the complex postoperative ECF. Patient and Methods: Patients with postoperative ECF were enrolled in this prospective study in the period from January 2018 to June 2019. Full history, examination and investigations were done for all patients. Patients had VAC. After one month, responses to VAC in terms of time from fistula to VAC, general condition, fistula output, fistula closure, wound size, skin condition, time to start oral feeding, need to segregate, complications and mortality were recorded. On follow-up, time to complete closure, type of closure and cost were recorded. Results were then analyzed. Results: 60 patients with ECF were enrolled. General condition was improved in 32 patients while ECF output was improved in 52 patients. Early start of Oral feeding had occurred with the use of VAC. Complications as pain, new fistula formation, pulmonary embolism or ongoing sepsis occurred in 40 patients while mortality occurred in 12 patients. Conclusion: VAC is feasible in complex postoperative enterocutaneous fistulae. It enhances the survival, improves the general condition and the perifistular skin and reduces the fistula output and wound size.

A fatal acute appendicitis with sepsis and pneumonia was caused by melioidosis: a case report

We report anunderdiagnosed fatal case of melioidosis that involved dygestion system which complicated with pneumonia, and sepsis. The case was initially diagnosed as acute appendicitis, and subsequently the patient underwent an exploratory laparatomy and appendectomy. He was discharged afer 3 days of hospitalization. Thirty days afterward, he was admitted to another private hospital to experience another exploratory laparatomy with indication of pancreatitis, intra-abdominal organs adhesions, and postoperative enterocutaneous fistula (ECF), and hospitalized there for 25 days. He eventually suffered from sepsis, pneumonia, unclosed ECF, anemia, hypoalbuminemia, and electrolyte imbalance. He then referred to a tertiary teaching hospital and hospitalized there for a total 134 days until he passed away. His clinical condition was declining, despite a long course of broad spectrum antibiotics. Treatment delay, prolong hospitalization, and complications were the inevitable, although Burkholderia pseudomallei was finally identified 2 weeks prior to his death. This case highlight that melioidosis canassociate with acute appendicitis, and that the delay on its diagnosis and treatment may trigger complications and death.

Analysis of risk factors for postoperative enterocutaneous fistula after inguinal hernia free tension repair

Objective To analyze the risk factors for postoperative enterocutaneous fistula after inguinal hernia free tension repair. Methods The retrospective case-control study was conducted. The clinical data of 679 patients who underwent inguinal hernia free tension repair between January 2015 and September 2018 in Beijing Chao-Yang Hospital of Capital Medical University were collected. There were 646 males and 33 females, aged (65±12)years, with a range from 28 to 94 years. Observation indicators: (1) surgical situations of inguinal hernia free tension repair; (2) follow-up; (3) enterocutaneous fistula and its treatment; (4) risk factors for postoperative enterocutaneous fistula after inguinal hernia free tension repair. Follow-up by outpatient examination and telephone interview was performed to detect the postoperative enterocutaneous fistula up to June 2019. Measurement data with normal distribution were represented as Mean±SD. Count data were described as absolute numbers. Univariate analysis and multivariate analysis were done using the chi-square test and Logistic regression model, respectively. Results (1) Surgical situations of inguinal hernia free tension repair: 679 patients underwent inguinal hernia free tension repair. Of 679 patients, 215 underwent plug repair or mesh-plug repair, including 9 cases undergoing Plug repair only, 50 undergoing Millikan procedure, and 156 undergoing Rutkow procedure, other 464 underwent non-plug surgery, including 181 undergoing Lichtenstein procedure, 53 undergoing transinguinal preperitoneal hernia repair (TIPP), and 230 undergoing transabdominal preperitoneal patch repair (TAPP) and total extraperitoneal inguinal hernia repair (TEP). Polypropylene mesh or plug were used in all 679 cases. The operation time and volume of intraoperative blood loss were (61±14)minutes and (10±7)mL. There were 580 of 679 patients treated with prophylactic antibiotics. (2) Follow-up: 679 patients were followed up for 15-86 months, with a median time of 51 months. There were 12 male patients with postoperative enterocutaneous fistula, aged (69±8)years, with a range from 57 to 79 years, twelve patients with enterocutaneous fistula developed symptoms within the time of (42±25)months. (3) Enterocutaneous fistula and its treatment: of 12 patients with enterocutaneous fistula, 11 underwent plug repair or mesh-plug repair, and 1 undergwent TAPP(enterocutaneous fistula secondary to invasion of preperitoneal patch to intestines). The fistulas were located at inguinal region, with a diameter of 0.5-1.0 cm. In the 12 patients, of the 5 patients with sigmoid fistula, 4 underwent intestinal resection around the fistula, 1 underwent distal bowel closure and proximal colostomy. Six patients had enteric fistula, including 5 secondary to invasion of plug to intestines and 1 due to preperitoneal patch in TAPP, and they underwent resection of intestines with fistula combined with side-to-side intestial anastomosis, or laparoscopic suture of all layers and seromuscular layer of enterocutaneous fistula. One patient with intestinal and vesical fistulas underwent resection of intestines with fistula, and had sutured and embeded them with 3-0 absorbable strings. Operation time of 12 patients was (126±40)minutes. Five patients received debridement and drainage for reoperation. Duration of hospital stay of 12 patients was (37±11)days. (4) Risk factors for postoperative enterocutaneous fistula after inguinal hernia free tension repair: results of univariate analysis showed that surgical method was associated factor for postoperative enterocutaneous fistula after inguinal hernia free tension repair (χ2=17.601, P<0.05). Results of multivariate analysis showed that plug repair or mesh-plug repair was an independent risk factor for postoperative enterocutaneous fistula after inguinal hernia free tension repair (odds ratio=32.279, 95% confidence interval: 4.027-258.735, P<0.05). Conclusion The plug repair or mesh-plug repair is an independent risk factor for postoperative enterocutaneous fistula after inguinal hernia free tension repair. Key words: Hernia; Inguinal hernia; Tension free repair; Plug; Enterocutaneous fistula; Risk factors

1690 Management of Non-Malignant Enterocutaneous Fistula Using Fully Covered Stent

INTRODUCTION: Postoperative enterocutaneous fistula (ECF) has a reported prevalence of 3.6% in general surgery, and up to 35% in Crohn disease-related surgery. ECFs can be of low-output, drain &lt; 200 mL/day, or of high-output, drain &gt; 500 mL/day, which unlikely to heal spontaneously. ECFs can cause metabolic disturbances, fluid loss, and malnutrition. CASE DESCRIPTION/METHODS: Case 1: A 54-year-old man with a history of colonic transmural necrosis status post multiple surgeries and end transverse colostomy placement, presented with a two-week history of passing stool from the lateral aspect of his peristomal incision, consistent with enterocutaneous fistula. The 2 fistulae ends were seen on the skin, laterally to the stoma (Figure 2c), and both other ends were identified in the stoma lumen. CT fistulogram confirmed the fistulae. After advancing the endoscope into the stoma, a 2 cm friable stenosis was seen (Figure 1a). The fistulae tracts were treated with silver nitrate and were injected with fibrin glue. A 20 mm × 6 cm fully-covered stent was placed (Figure 1b) and sutured in place. A month later the fistulae had healed (Figure 2d), with no recurrence reported. Case 2: A 64-year-old man with a history of metastatic mucinous appendiceal cancer status post multiple abdominal surgeries, referred for his recurrent ECF. CT scan showed air tracking outside the colon at the level of the cutaneous fistula site. Water-soluble contrast pushed through the rectum showed an occlusion with contrast extravasation is seen in the fistula (Figure 3e). Sigmoidoscopy confirmed the site of obstruction and the area of leakage. A fully covered stent was placed to relieve the obstruction and cover the fistula (Figure 3f). Initially, the fistula output resolved, but when the stent was removed a month later, the fistula output returned. So, a stent was placed again and was sutured to the colon. The patient is now asymptomatic and having normal bowel movements. DISCUSSION: ECF can cause significant morbidity and affect the quality of life. Surgical repair of ECF has a recurrence rate as high as 36% and is associated with high mortality especially in malnourished patients. Thus, endoscopic intervention using fully-covered stents can be helpful in healing the fistulae. In these 2 cases, the placement of a fully-covered stent relieved the coexisting obstruction, diverted the flow away from the fistula, and simultaneously covered the fistula end. The patients experienced relief of fistula symptoms and avoided them major surgical intervention. Watch the video: http://bit.ly/30BIvtw.

Management of post-operative enterocutaneous fistula

Management of post-operative enterocutaneous fistula

Surgical Outcomes in Patients with Abdominal Cocoon: Series of 15 Patients.

Abdominal cocoon (AC) or sclerosing encapsulating peritonitis is an uncommon cause of intestinal obstruction. Surgical intervention is warranted in patients with persistent pain or intestinal obstruction. A retrospective analysis of patients operated for AC was performed. Clinical presentation, radiological data, postoperative outcomes (Ryles tube (RT) removal, duration of hospital stay, enterocutaneous fistula, requirement for re-exploration and mortality) were retrieved and analyzed. Fifteen patients of abdominal cocoon required surgical intervention for various indications. The mean age was 34.46years (13-60), and 11 (73.3%) were males. Intermittent abdominal pain was present in 14 (93.3%) followed by recurrent subacute intestinal obstruction (SAIO) in 11 (73.3%). Three patients presented with intestinal perforation. Of the 14 patients with preoperative computed tomography, radiological diagnosis was possible in five patients. The mean duration for surgery was 159min (60-360min). Membrane encasement was complete in 9/15 and partial in 6/15 patients. Adhesiolysis was done in all patients (complete-10/15 and partial-5/15). Mean duration for RT removal and hospital stay was 4.3 and 12.3days, respectively. Recurrence of SAIO was observed in three patients, and one patient needed re-exploration for the same. One patient developed postoperative enterocutaneous fistula requiring surgical intervention. Overall mortality in the study was 13.3% (2/15). Four patients had underlying tuberculosis, and the rest were idiopathic. Etiology of AC is not known in majority of patients. Persistent pain and recurrent SAIO are the most common indications for surgery. This morbidity associated with surgery can be reduced by meticulous dissection techniques and appropriate peri-operative care.

The challenge in diagnosing Crohn’s disease in TB endemic region – A case report with review of literature

The challenge in diagnosing the regional ileitis existed since 1932 when Crohn, Ginzberg and Oppenheimer first reported their case1. Many Indian researchers accepted that during last decade there was considerable increase in the incidence of Crohn’s disease (CD) in India which poses great challenge in diagnosing it, due to high prevalence of tuberculosis2. In this perspective we report a case which made a stimulus to review the literature. The purpose of this manuscript is 1. To document the occurrence of an additional case of CD in India, 2. To report that CD can rarely present as post operative enterocutaneous fistula, 3. To discuss the criteria in diagnosing the CD in Tuberculosis (TB) endemic area.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.688-690

Postoperative enterocutaneous fistula - principles in non-operative approach.

IntroductionPostoperative enterocutaneous fistulae could constitute a challenge when they occur following an abdominal surgery. Astute application of correct principles in its management is essential for good outcomes.MethodsA retrospective review of records of patients with enterocutaneous fistulas managed non-operatively was done. Clinical assessment, anatomic and physiologic classification of fistula, fluid resuscitation, electrolyte correction, parenteral/enteral nutrition, antibiotic use and fistula effluent monitoring, formed the basis of management.Results(4/14)Four out of 14 patients with enterocutaneous fistulae were managed exclusively non-operatively. Their ages ranged between 34 and 63 years. Mean age 46years. All four fistulae occurred postoperatively. Laparatomy for ectopic pregnancy, bowel obstruction constituted the primary surgery. There were two high output cases and two low output cases. Initial parenteral nutrition was employed in two cases while enterals were used solely in two cases. Fistula closure was achieved in all 4 cases at durations ranging from 7 to 16 days, a mean time of 12.5 days.ConclusionNon-operative approach to management for postoperative enterocutaneous fistulas was successful in these cases.

Evaluation and Management of Post-Operative Enterocutaneous Fistula

Evaluation and Management of Post-Operative Enterocutaneous Fistula

Surgery for post-operative entero-cutaneous fistulas: is bowel resection plus primary anastomosis without stoma a safe option to avoid early recurrence? Report on 20 cases by a single center and systematic review of the literature.

A review was performed on entero-cutaneous fistula (ECF) repair and early recurrence, adding our twenty adult patients (65% had multiple fistulas). The search yielded 4.098 articles but only 15 were relevant: 1.217 patients underwent surgery. The interval time between fistula's diagnosis and operative repair was between 3 months and 1 year. A bowel resection with primary anastomosis was performed in 1.048 patients, 192 (18.3%) underwent a covering stoma: 856 patients (81.7%) had a fistula takedown in one procedure. The patients had 14.3% recurrence and 13.1% mortality rate. In our experience 75% were surgically treated after a period equal or above one year from fistula occurrence: surgery was very demolitive (in 40% remnant small bowel was less than 100 cm). We performed a bowel resection with a hand-sewn anastomosis (95%) without temporary stoma. In-hospital mortality was 0% and at discharge all were back to oral intake with 0% early re-fistulisation. Literature supports our experience: ECF takedown could be safely performed after an adequate period of recovery from 3 months to one year from fistula occurrence. In our series primary repair (bowel resection plus reconnection surgery without temporary stoma) avoided an early recurrence without mortality.