title: A laparoscopic approach to the surgical management of enterocutaneous fistula in a wound healing by secondary intention.
abstract: Traditional surgical management of a chronic enterocutaneous fistula requires laparotomy, but the optimal site of incision is unclear. Laparoscopy and adhesiolysis may offer an alternative approach. Two cases of non-healing enterocutaneous fistula within chronic, granulating wounds are described. The laparoscope was placed subcostally using the Hasson technique with additional ports placed under direct vision. After clearing the anterior abdominal wall of all but the fistula-containing bowel, an incision was made circumferentially around the granulation bed. Resection and primary anastomosis was performed in standard fashion. Lateral component separation allowed primary wound closure. Both patients were discharged without sequelae and doing well at last follow-up (mean 12 months). A laparoscopic approach to non-healing enterocutaneous fistulas seems safe and technically feasible. When combined with lateral component separation, it may result in reduction of inadvertent enterotomies and optimal management of the wound without the use of prosthetic mesh.
authors.affiliation: Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA.
authors.forename: G D
authors.initials: GD
authors.lastname: Garcia
authors.forename: I H G
authors.initials: IH
authors.lastname: Freeman
authors.forename: S M
authors.initials: SM
authors.lastname: Zagorski
authors.forename: M H
authors.initials: MH
authors.lastname: Chung
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000230:Adenocarcinoma / Q000188:drug therapy / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D017024:Chemotherapy, Adjuvant; D002908:Chronic Disease; D003082:Colectomy; D044684:Colon, Transverse / Q000601:surgery; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000601:surgery; D003125:Colostomy; D003131:Combined Modality Therapy; D017577:Cutaneous Fistula / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D000267:Tissue Adhesions / Q000601:surgery; D014945:Wound Healing