title: Treatment strategies in 135 consecutive patients with enterocutaneous fistulas.
abstract: BACKGROUND
  Enterocutaneous fistulas (ECF) pose a major challenge to every gastrointestinal (GI) surgeon. Based on earlier studies, a standardized treatment guideline was implemented. The focus of the present study was to assess that guideline and determine prognostic factors for outcome of patients with ECF, and to define a more detailed therapeutic approach including the convalescence time before restorative surgery.
  
  
  METHODS
  All patients with ECF treated between 1990 and 2005 were included. Management consisted of controlling Sepsis, Optimization of nutritional state, Wound care, assessment of fistula Anatomy, Timing of surgery, and Surgical strategy (the SOWATS guideline). Prognostic factors were assessed by way of multiple logistic regression analysis.
  
  
  RESULTS
  A total of 135 patients were treated at our unit. Overall closure was achieved in 118 patients (87.4%). Restorative operations for fistula closure were performed after a median of 53 days (range: 4-270 days). Restorative operations were successful in 97/107 patients (90.7%). Thirteen patients (9.6%) died. An abdominal wall defect was the most predominant negative prognostic factor for spontaneous closure (odds ratio [OR]=0.195, confidence interval [CI] 0.052-0.726, p=0.015). A strong relation was found between preoperative albumin level and surgical closure (p<0.001) and mortality (p<0.001).
  
  
  CONCLUSIONS
  Application of the SOWATS guideline allowed a favorable outcome after a short convalescence period. Abdominal wall defects and preoperative hypoalbuminemia are important prognostic variables.
authors.affiliation: Department of Surgery, Intestinal Failure Institute Maastricht and Nutrition & Toxicology Research Institute Maastricht, University Hospital Maastricht, Maastricht, The Netherlands.
authors.forename: Ruben G J
authors.initials: RG
authors.lastname: Visschers
authors.forename: Steven W M
authors.initials: SW
authors.lastname: Olde Damink
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.forename: Peter B
authors.initials: PB
authors.lastname: Soeters
authors.forename: Wim G
authors.initials: WG
authors.lastname: van Gemert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017577:Cutaneous Fistula / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D017410:Practice Guidelines as Topic / Q000592:standards; D012044:Regression Analysis; D012189:Retrospective Studies