title: Single-stage closure of enterocutaneous fistula and stomas in the presence of large abdominal wall defects using the components separation technique.
abstract: BACKGROUND
  Closure of an enterocutaneous fistula and/or stomas in the presence of large abdominal wall defects is a challenging problem. In the present study, the results of the components separation technique are described.
  
  
  METHODS
  All patients with an enterocutaneous fistula and/or stomas in the presence of large abdominal wall defects (ie, laparostomy of ventral hernia) who underwent a single-stage repair using the components separation technique in the period from January 2000 to July 2007 were reviewed retrospectively.
  
  
  RESULTS
  A total of 32 patients were included. The median operating time was 204 minutes (range 87-573). In 18 patients, additionally to the components separation, an absorbable mesh was used. Postoperatively, in 16 patients 22 complications were reported. There were 9 patients with local wound problems. The median postoperative hospital stay was 12 days (range 5-74). Seven patients developed a ventral hernia. Four of them were small asymptomatic recurrences. Four out of the 15 patients with an enterocutaneous fistula developed a recurrent fistula. The median follow-up was 20 months (range 3-54).
  
  
  CONCLUSIONS
  Closure of enterocutaneous fistula and/or stomas and simultaneous repair of large abdominal wall defects is feasible using the components separation technique but morbidity is considerable. Early recurrence of abdominal hernia and fistula is acceptable.
authors.affiliation: Department of Surgery, Academic Medical Center, Postbox 22660, 1100 DD Amsterdam, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Wind
authors.forename: Paul J
authors.initials: PJ
authors.lastname: van Koperen
authors.forename: J Frederik M
authors.initials: JF
authors.lastname: Slors
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000379:methods; D054047:Surgical Stomas; D055815:Young Adult