Treatment of Postoperative Enterocutaneous Fistulas by High-Pressure Vacuum with a Normal Oral Diet

Abstract

Background/Aims: Enterocutaneous fistulas are associated with prolonged hospital stay, high morbidity/mortality, and increased hospital costs. This study aims to describe the use of a vacuum system and normal oral diet in dealing with this problem. Methods: Seventy-four consecutive patients with recent and defined external postoperative fistulas were analyzed. Abdominal imaging was used to exclude abscess and distal obstruction. The fistula tract was sealed with Foley catheter, connected to a negative pressure flask, changed daily for 5, 10 or 15 days, as necessary. A normal oral diet was permitted. Results: No patient died. Serum albumin and transferrin showed significantly higher levels at the end of treatment than at the beginning. The moderate and low-output fistulas had the best results (97% closed). Forty-eight (65%) fistulas closed after 5 days, 16 (22%) after 10 days and 4 (5%) after 15 days. Treatment failed in 6 (8%) patients, who subsequently underwent surgery. The fistula did not close in 1 patient with a low output. The cost of the treatment was USD 41.75/day and it was considered cost-effective. Conclusions: The vacuum system demonstrated good results in the treatment of fistulas. It included simplicity, low cost, short hospital stay, absence of skin breakdown, normal eating, good nutrition and activity patterns.

Management of Enterocutaneous Fistulas Using Negative-Pressure Dressings

“…Since that time, others have corroborated our findings through a case report, 7 a small case series, 8 and a larger case series that suggested that negative-pressure dressing may improve outcomes over standard conservative therapy in patients with ECFs. 9 Throughout the 1980s and early 1990s, there was much interest in the potential for somatostatin agonists, such as octreotide, to increase closure rates in patients with ECFs. Despite many studies suggesting that these agents did improve outcomes, a general consensus was reached that they provided only a modest benefit over traditional conservative therapy.…”

“…[7][8][9] The purpose of this report is to examine the factors associated with successful closure of ECFs treated with negative-pressure dressings. Our closure rate is then compared with rates reported in the literature with standard conservative management.…”

Nutrition and management of enterocutaneous fistula

“…This has the potential advantage of preserving small bowel secretions, although it is unacceptable to many patients. Another technique that has been used to facilitate enteral feeding is vacuum sealing of the fistula tract86–88. This has been described in a series of 74 patients with postoperative enterocutaneous fistula who were fed orally; a high rate of spontaneous fistula closure was reported87.…”

Management of enteroatmospheric fistulae

“…On the other hand, use of NPWT in the OA has been reported in several case reports and case series with good or even excellent results. Authors have concluded that NPWT has been safe and has not been associated with a high incidence of enteric fistulae . Several novel methods and devices have been developed to improve the treatment provided to patients with OA.…”