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Enterocutaneous fistula: a single‐centre experience
Author(s) -
Gyorki D. E.,
Brooks C. E.,
Gett R.,
Woods R. J.,
Johnston M.,
Keck J. O.,
Mackay J. R.,
Heriot A. G.
Publication year - 2010
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.05086.x
Subject(s) - medicine , enterocutaneous fistula , radiation enteritis , surgery , parenteral nutrition , fistula , anastomosis , etiology , mortality rate , retrospective cohort study , radiation therapy
Background: Enterocutaneous fistulae (ECFs) present a difficult management problem and can cause significant morbidity. The aim of the study was to assess the outcome of these patients. Methods: A retrospective chart review of all patients with ECF managed at a tertiary centre between 1996 and 2006 was performed. Demographic, management and outcome data including ECF closure, morbidity and mortality were recorded. Results: A total of 33 patients (17 male) were identified with ECF (median age: 63 years, range: 27–84). The primary aetiology was Crohn's (30%), anastomotic leak (24%), iatrogenic (18%), mesh (6%), neoplasia (6%) and other (16%). Definitive surgery was undertaken in 21 (64%) at a median of 6.4 months (0.4–72 range) following presentation. Twenty percent of patients required emergency surgical intervention and 5 patients required preoperative total parenteral nutrition (TPN). Surgical management was formal resection and reanastomosis in all patients, with a mean operative time of 4.75 h (standard deviation = 1.8). The median hospital stay for the operative group was 19 days (7–85). Four patients required post‐operative TPN with one patient requiring home TPN. Fistula closure rate was 97% (operative group: 21 out of 21; non‐operative group: 11 out of 12). Mean follow‐up was 37.3 months (0.5–217). Six (19%) operative patients developed fistula recurrence. There were two deaths at 2 and 5 months (fistula aetiology malignant colonic fistula and radiation enteritis, respectively). Conclusion: Patients with ECF can be treated with low morbidity and low recurrence rate in a multidisciplinary setting. We believe that patients with ECF should be referred to specialist units for management.