Definitive surgical closure of enterocutaneous fistula: outcome and factors predictive of increased postoperative morbidity

Ravindran, Praveen; Ansari, Nabila; Young, Christopher J.; Solomon, Michael J.

doi:10.1111/codi.12473

Cited by 37 publications

(48 citation statements)

References 29 publications

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“…Reconstructive surgery was associated with considerable morbidity. Despite advances in care and surgical technique, high rates of postoperative morbidity are still described. The postoperative in‐hospital mortality rate here is comparable to the rates of 2–5 per cent reported previously.…”

Section: Discussionsupporting

confidence: 68%

Outcome of acute intestinal failure

Atema

Mirck

Arum

et al. 2016

British Journal of Surgery

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Section: Discussionsupporting

confidence: 68%

Outcome of acute intestinal failure

Atema

Mirck

Arum

et al. 2016

British Journal of Surgery

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“…In the patient with a proximal fistula and/or a very high output it may be preferable to manage the situation with a rested gut and full PN [104,105], but even then, the psychological benefit of eating may warrant its inclusion in the nutritional regimen despite minimal expectations of useful nutrient absorption [102]. Surgical correction is more likely to be successful if nutritional status has been optimized pre-operatively [106].…”

Section: Grade Of Recommendation B E Strong Consensus (96% Agreement)mentioning

confidence: 99%

ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease

et al. 2020

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“…Sources of contamination such as the presence of a stoma, concomitant bowel surgery, enterocutaneous fistulas (ECF) or infected mesh increase the risk of wound complications [1,2]. Additionally, patients may have coexisting intestinal failure, possibly worsening postoperative morbidity [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes after contaminated complex abdominal wall reconstruction

Vries

Hodgkinson

Claessen

et al. 2020

Hernia

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Purpose Complex abdominal wall repair (CAWR) in a contaminated operative field is a challenge. Available literature regarding long-term outcomes of CAWR comprises studies that often have small numbers and heterogeneous patient populations. This study aims to assess long-term outcomes of modified-ventral hernia working group (VHWG) grade 3 repairs. Because the relevance of hernia recurrence (HR) as the primary outcome for this patient group is contentious, the need for further hernia surgery (FHS) was also assessed in relation to long-term survival. Methods A retrospective cohort study with a single prospective follow-up time-point nested in a consecutive series of patients undergoing CAWR in two European national intestinal failure centers. Results In long-term analysis, 266 modified VHWG grade 3 procedures were included. The overall HR rate was 32.3%. The HR rates for non-crosslinked biologic meshes and synthetic meshes when fascial closure was achieved were 20.3% and 30.6%, respectively. The rates of FHS were 7.2% and 16.7%, and occurred only within the first 3 years. Bridged repairs showed poorer results (fascial closure 22.9% hernia recurrence vs bridged 57.1% recurrence). Overall survival was relatively good with 80% en 70% of the patients still alive after 5 and 10 years, respectively. In total 86.6% of the patients remained free of FHS. Conclusions In this study of contaminated CAWR, non-crosslinked biologic mesh shows better results than synthetic mesh. Bridging repairs with no posterior and/or anterior fascial closure have a higher recurrence rate. The overall survival was good and the majority of patients remained free of additional hernia surgery.As 80% of patients are still alive at 5-year follow-up and 86.6% of the patients remained free of additional surgery, the initial higher costs of a non-crosslinked biologic mesh seem trivial.

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Definitive surgical closure of enterocutaneous fistula: outcome and factors predictive of increased postoperative morbidity

Abstract: The majority of persistent complex ECFs can be cured surgically with low mortality and recurrence in a multidisciplinary setting. Postoperative morbidity, however, remains a significant burden.

Cited by 37 publications

References 29 publications

Outcome of acute intestinal failure

Outcome of acute intestinal failure

ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease

Long-term outcomes after contaminated complex abdominal wall reconstruction

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