title: Treatment of postoperative enterocutaneous fistulas by high-pressure vacuum with a normal oral diet.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Surgery, School of Medicine, Federal University of Rio Grande do Norte, Natal, Brazil. aldo@ufrnet.br
authors.forename: Aldo Cunha
authors.initials: AC
authors.lastname: Medeiros
authors.forename: Tertuliano
authors.initials: T
authors.lastname: Aires-Neto
authors.forename: Julio Sérgio
authors.initials: JS
authors.lastname: Marchini
authors.forename: Jose
authors.initials: J
authors.lastname: Brandão-Neto
authors.forename: Dione Maria
authors.initials: DM
authors.lastname: Valença
authors.forename: Eryvaldo Sócrates Tabosa
authors.initials: ES
authors.lastname: Egito
mesh_terms: D000328:Adult; D004032:Diet; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000032:analysis; D014168:Transferrin / Q000032:analysis; D016896:Treatment Outcome; D014618:Vacuum
chemical_list: D012709:Serum Albumin; D014168:Transferrin