Treatment of high-output enterocutaneous fistulas with a vacuum-compaction device. A ten-year experience.
BACKGROUND
Enterocutaneous fistulas arise as complications in 0.8%-2% of abdominal operations. The global mortality rate is 5%-37%, yet it may exceed 60% in the case of high-output fistulas and when sepsis and malnutrition are involved. The objective of this prospective cohort study with retrospective data analyses was to analyze our ten-year experience with a vacuum-compaction device for the management of high-output, postoperative enterocutaneous fistulas at the Department of General Surgery, E. Tornú Hospital, and the Intensive Care Unit, Churruca Hospital, Buenos Aires, Argentina.


METHODS
Ninety-one patients presented 179 fistulas; 73 (69.2%) were men whose mean age was 48 years. Sepsis and malnutrition were present in 66 (72.5%). The mean initial fistula output was 1,485 ml/day. Conservative management was carried out according to diagnostic and therapeutic priority staging. A vacuum-compaction system (SIVACO; Spanish acronym) was used to control output.


RESULTS
Output was entirely suppressed in 37 (40.7%) patients after 1-7 days of treatment, and reduced to less than 500 ml/day (average=138) in 52 (57.1%) patients. Spontaneous closure was achieved in 42 (46.2%) patients, whereas 37 (40.7%) patients did not improve after 20-380 (average=111) days of treatment. Those patients required surgical correction, which had an 83.8% success rate. Overall mortality was 16.5% (15 patients).


CONCLUSIONS
The vacuum-compaction device proved effective for reducing fistula output in 89 of 91 patients (97.8%).
Wainstein
Daniel Edgardo
DE
Cirugía General, Hospital E. Tornú Ex Combatientes de Malvinas 3002, Ciudad de Buenos Aires, 1427, Argentina. dwainstein@telered.com.ar
Fernandez
Ernesto
E
Gonzalez
Daniel
D
Chara
Osvaldo
O
Berkowski
Dario
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D015331:Cohort Studies; D017577:Cutaneous Fistula / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation / Q000379:methods; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome