Management of enterocutaneous fistulae: A 10 years experience

Abstract

AIM:To compare the outcomes of conservative vs sur gical treatment of enterocutaneous fistulae (ECF) in a community teaching hospital over a decade. METHODS:All cases of ECF between 1997 and 2007 were reviewed for management strategy. RESULTS:Of the 83 patients with ECF, 60 (72%) were postoperative. Sixtysix patients (79.5%) were treated initially with conservative measures. Eighteen patients failed to respond to conservative treatment and required later (secondary) exploration; this group consisted of an equal number of low vs high output fistulae. Seventeen (20.5%) patients underwent initial (primary) definitivesurgery secondary to anastomotic leak and peritonitis. Surgical procedures included resection of ECF with anastomosis (24), exclusion (6) and directdrainage (4). No significant difference was seen in the recurrence rate for conservative (10%) vs operativetreatment (20%). CONCLUSION:Conservative treatment plays a pivotal role as an initial management in both low and high out put fistulae. In selective cases only, early primary explo ration is recommended.

Nutritional management of enterocutaneous fistula: a retrospective study at a Malaysian university medical center

“…The cases were managed conservatively, as recommended by the published studies on management of fistula,4,7,10,22 with the exception of one case that was treated surgically. Conservative treatment was used to build up nutritional status, stabilize the patient before surgery, improve the surgical outcome, and decrease the risk of postoperative complications 11.…”

“…Management of enterocutaneous fistula is a challenge for surgeons, gastroenterologists, and allied health professionals1–4 because of the serious complications that can occur, ie, malnutrition, sepsis, and fluid and electrolyte disturbances,5 known as the “fistula triad” 6. The main goal in management of enterocutaneous fistula is to restore the integrity of the patient’s gastrointestinal tract to allow normal feeding while minimizing morbidity and mortality 3.…”

Role of Vacuum assisted Negative pressure wound therapy in management of Enterocutaneous fistulae arising within the open abdomen: three case studies.

“…Newer therapies including wound vacuum assisted closure (VAC), fibrin glue and the use of somatostatin analogues have been used to promote the closure of ECF [16].…”

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

“…A recent case series suggests a mortality rate of 6 to 33% associated with ECF [1]. The current standard of treatment for low output ECF is a conservative management, which usually lasts for months with recent reviews concluding that this can only resolve 30–60% of the fistula [2, 3]. The unresolved ECF require surgical management for closure following months of conservative management.…”