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

Abstract

Background. A review was performed on entero-cutaneous fistula (ECF) repair and early recurrence, adding our twenty adult patients (65% had multiple fistulas).Methods.

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

“…And surgical repairs are more prone to high morbidity and mortality [18][19][20]. Also, the occurrence of this complication significantly increases the length and cost of hospital stay, and patient's suffering [1][2][3][4]21].…”

Meeting Report of the XIV International Small Bowel Transplant Symposium: Summary of Presentations, Workshops, and Debates From a Comprehensive Meeting on Intestinal Failure, Rehabilitation, and Transplantation, Buenos Aires, Argentina, June 10–13, 2015

“…Autologous gastrointestinal tract reconstructive surgery (AGITRS) became a major focus of scientific presentations during the symposium. Several abstracts reinforced the benefits of these surgical interventions in achieving intestinal autonomy in up to 74% of adult patients and long‐term survival in 77%; improved quality of life was also reported as a benefit of AGITRS . AGITRS appears to be an excellent alternative for patients suffering from short bowel syndrome after bariatric surgery .…”

Comment on Klek et al. Enhanced Recovery after Surgery (ERAS) Protocol Is a Safe and Effective Approach in Patients with Gastrointestinal Fistulas Undergoing Reconstruction: Results from a Prospective Study. Nutrients 2021, 13, 1953

“…We do agree that ERAS protocols have demonstrated their efficacy after colorectal surgery [ 2 ], but the unquestionable novelty of the study by Klek et al requires further discussion. Surgery for entero-cutaneous fistulas represents a challenge [ 3 , 4 ]: in our previous systematic review of the literature on this topic [ 5 ], we included in our study 1217 patients. A bowel resection with primary anastomosis was performed in 1048 patients, and 856 patients (81.7%) had a fistula takedown in one procedure without a temporary covering stoma.…”

“…The matter does not represent a futile topic under the clinical point of view: a staged operation [ 6 ] or primary anastomosis without stoma [ 5 ] could determine relevant implications on the patient’ recovery, and these factors should be considered to fully evaluate the modified ERAS protocol as safe and effective in patients treated for gastrointestinal fistulas.…”