Outcome of reconstructive surgery for intestinal fistula in the open abdomen.
OBJECTIVE
To determine factors which influence the outcome of surgical techniques to close enterocutaneous fistulas within the open abdomen.


BACKGROUND
Enterocutaneous fistulation within an open abdominal wound is associated with considerable morbidity and mortality. The factors that influence the outcome of reconstructive surgery are unclear.


METHODS
Sixty-one patients undergoing 63 operations to close enterocutaneous fistulas associated with open abdominal wounds were referred to a national center for further management. Once sepsis had been eradicated, nutritional status restored and local conditions in the abdomen judged to be suitable, fistulas were resected and the abdominal wall reconstructed by suture repair with and without component separation, or by suture repair in combination with absorbable or nonabsorbable prosthetic mesh. Patients were followed up for 16 to 84 months postoperatively.


RESULTS
There were 3 postoperative deaths (4.8%). Major complications, including postoperative respiratory and surgical site infection occurred in 52 of 63 (82.5%) procedures. Refistulation occurred in 7 cases (11.1%) but was more common when the abdominal wall was reconstructed with prosthetic mesh (7 of 29, 24.1%) than with sutures (0 of 34, 0%). Porcine collagen mesh was associated with a particularly high rate of refistulation (5 of 12, 41.7%).


CONCLUSIONS
Simultaneous reconstruction of the intestinal tract and abdominal wall remains associated with a high complication rate, justifying the management of such patients in specialized units. Simultaneous reconstruction of the abdominal wall with prosthetic mesh is associated with a particularly high incidence of recurrent postoperative fistulation and should be avoided if possible.
Connolly
Patrick T
PT
Intestinal Failure Unit, Department of Surgery, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
Teubner
Antje
A
Lees
Nicholas P
NP
Anderson
Iain D
ID
Scott
Nigel A
NA
Carlson
Gordon L
GL
D000007:Abdominal Injuries / Q000601:surgery*; D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007412:Intestinal Fistula / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013526:Surgical Mesh; D013536:Suture Techniques; D016896:Treatment Outcome