Operative Surgery for Enterocutaneous Fistula

ABSTRACT

The management of the patient with an enterocutaneous fistula is complex and requires coordinated care on many fronts for successful elimination. With optimal nonoperative management a fistula may heal spontaneously, the majority within the first 4 weeks after development. Definitive surgical treatment is best achieved with resection of the bowel containing the fistula and anastomosis of healthy normal bowel. The timing of definitive surgery appears to be optimal months after development, if tolerated. Death rates are low after surgery and patients who experience the recurrence of a fistula after initial attempt at closure can ultimately still be cured.

KEYWORDS

Enterocutaneous fistulas - operative management - timing - resection

REFERENCES

• 1 Edmunds Jr L H, Williams G M, Welch C E. External fistulas arising from the gastro-intestinal tract.  Ann Surg. 1960;  152 445-471
• 2 Soeters P B, Ebeid A M, Fischer J E. Review of 404 patients with gastrointestinal fistulas. Impact of parenteral nutrition.  Ann Surg. 1979;  190(2) 189-202
• 3 Fischer J E. The pathophysiology of enterocutaneous fistulas.  World J Surg. 1983;  7(4) 446-450
• 4 Martinez J L, Luque-de-Leon E, Mier J, Blanco-Benavides R, Robledo F. Systematic management of postoperative enterocutaneous fistulas: factors related to outcomes.  World J Surg. 2008;  32(3) 436-443, discussion 444
• 5 Reber H A, Roberts C, Way L W, Dunphy J E. Management of external gastrointestinal fistulas.  Ann Surg. 1978;  188(4) 460-467
• 6 Hollington P, Mawdsley J, Lim W, Gabe S M, Forbes A, Windsor A J. An 11-year experience of enterocutaneous fistula.  Br J Surg. 2004;  91(12) 1646-1651
• 7 Lynch A C, Delaney C P, Senagore A J, Connor J T, Remzi F H, Fazio V W. Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery.  Ann Surg. 2004;  240(5) 825-831
• 8 Hill G L. Operative strategy in the treatment of enterocutaneous fistulas.  World J Surg. 1983;  7(4) 495-501
• 9 Datta V, Engledow A, Chan S, Forbes A, Cohen C R, Windsor A. The management of enterocutaneous fistula in a regional unit in the United Kingdom: a prospective study.  Dis Colon Rectum. 2010;  53(2) 192-199