The Management of Enterocutaneous Fistula in a Regional Unit in the United Kingdom: A Prospective Study

Abstract

Our results compare favorably with data from designated national centers (overall mortality, 9.5%-10.8%; operative mortality, 3%-3.5%), suggesting that these patients can be effectively managed in regional units that have sufficient expertise, interest, and volume of patients. Rationalization of funding and referral of patients with type 2 intestinal failure to regional centers may allow national centers to conserve their scarce resources.

Enterocutaneous Fistulas: A Look at Causes and Management

“…A wellorganized management strategy utilizing of a multidisciplinary team approach is essential. A remarkable amount of time and labor along with intensive resource utilization yields closure rates ranging from 5 to 20 % without surgical intervention and 75-85 % with definitive operative treatment [2,3 • , 4, 5 [7][8][9][10][11]. The team members involved in the care of these complex patients include: general and reconstructive surgeons, nutritional support staff, bedside and enterostomal nursing, social workers, radiologists, internists, psychiatrists and physical therapists, among others [1].…”

Definitive Surgical Treatment of Enterocutaneous Fistula

“…[2][3][4][5][6][7][8] Unfortunately, nonoperative closure rates continue to remain low at 5% to 20%, and definitive operative closure is successful only 75% to 85% of the time. [2][3][4][5][6][7]9,10 Randomized studies regarding surgical management of ECF are nonexistent, and most accepted standards are based on expert opinion. Case series within the literature are limited, often involving small cohorts receiving surgical intervention from multiple surgeons and multiple institutions, thus allowing for uncontrolled differences in preoperative preparation, operative technique and skill level, and postoperative care and wound management.…”

“…Our 30-day and 1-year mortality rates (3.9% and 15.0%, respectively) are comparable with, and in some cases better than, rates reported in other series. [2][3][4][5][6][7]9,[15][16][17][18] Even though the surgical community has substantially decreased the mortality rate among patients with ECF, preventing and treating the problem remain as challenging as ever. As a result, trends within both our data and other series demonstrate that successful ECF closure and the morbidity rates associated with these interventions have shown very little improvement during the past few decades.…”

“…Case series within the literature are limited, often involving small cohorts receiving surgical intervention from multiple surgeons and multiple institutions, thus allowing for uncontrolled differences in preoperative preparation, operative technique and skill level, and postoperative care and wound management. [2][3][4][5][6][7] Additionally, many of these studies exclude certain patient populations (eg, patients with inflammatory bowel disease) or limit the cohort to specific types of ECF (eg, small-bowel fistulas only). This study aims to investigate the outcomes following surgical ECF management by a multidisciplinary team under the leadership of the same surgeon ( J.R.G.)…”

Enterocutaneous Fistula: Medical and Surgical Management Including Patients with Crohn's Disease

“…Although the origin of the ECF can be essentially anywhere along the gastrointestinal (GI) tract, they most commonly arise from small bowel, colon, stomach, and duodenum in decreasing order. 1,2 As spelled out elsewhere in this issue, the management of the ECF requires a multidisciplinary approach, which will often necessitate aggressive medical and surgical management to try to minimize morbidity and mortality. This is especially true in those patients with underlying inflammatory bowel disease, where the potential for a lifetime of disease recurrence and future function must always be considered.…”