Management of Enterocutaneous Fistula: Outcomes in 276 Patients

Abstract

Mortality remains high and is associated with sepsis. Fistulas proximal to the duodeno-jejunal flexure are more likely to close spontaneously. If the fistula fails to close spontaneously care is often prolonged and complex, requiring a dedicated nutrition team. In this series, spontaneous closure was more common in upper GI fistulas. Patients who are not able to be discharged in the interval between fistula formation and definitive surgery have a higher mortality risk.

Management of post-operative complications in open ventral hernia repair

“…Macroporous polypropylene and polyester mesh are more likely to be salvaged than PTFE due to its poor tissue ingrowth and biofilm formation. Conservative management should include opening the tract to control sepsis, nutritional support with TPN, somatostatin, downstream decompression, and appropriate wound care, which can lead to spontaneous closure in many cases [33] . If the fistula fails to close, it is recommended to wait for 6 month to allow for spontaneous closure and maturing of adhesions before mesh excision and bowel resection is undertaken [34] .…”

Enterocutaneous Fistula: A Simplified Clinical Approach

“…An enterocutaneous fistula is the most common type and represents 88.2% of all fistulae [22]. Quinn M et al reported, 89.1% of intestinal cutaneous fistula developed after abdominal surgery, followed by 6.88% occurring spontaneously, and 3.99% occurring after an endoscopic procedure [23]. In Crohn's disease, 21.7% of patients developed an enterocutaneous fistula on long-term follow-up [24].…”

SOP Postoperative enterokutane Fistel

“…Die Sterblichkeit von Patienten mit enterokutanen Fisteln beträgt zwischen 10 und 20 %. Die Behandlung ist langwierig und komplex und die postoperative Sterblichkeit nach operativen Eingriffen zum Verschluss enterokutaner Fisteln ist mit 5-10 % auch in aktuellen Untersuchungen erheblich [2]. Typ-I-ECF werden in den meisten Fällen in den Kliniken behandelt, in denen sie unmittelbar nach einer Operation aufgetreten sind.…”