Risk factors for recurrence after repair of enterocutaneous fistula.
OBJECTIVE
To assess outcomes after repair of enterocutaneous fistulae (ECF) and identify factors that predict mortality and recurrence.


METHODS
Retrospective study.


METHODS
University hospital.


METHODS
One hundred thirty-five patients undergoing ECF repair between 1989 and 2005.


METHODS
Mortality and recurrence of ECF.


RESULTS
Definitive operation for ECF was attempted in 135 patients. Mortality was 8%, recurrence was 17%, and 84% of patients eventually survived with a closed fistula. The primary determinant of mortality was ECF recurrence (odds ratio [OR], 6.7; 95% confidence interval [CI], 1.9-23.4). Factors independently associated with ECF recurrence by multivariate logistic regression included the presence of inflammatory bowel disease (OR, 4.9; 95% CI, 1.5-16.1), interval between diagnosis and operation of 36 weeks or longer (OR, 5.4; 95% CI, 1.8-16.4), location of fistulae in the small intestine (OR, 9.8; 95% CI, 1.7-57.6), and resection with stapled anastomosis (OR, 4.1; 95% CI, 1.3-13.2). Recurrence of ECF was 35% with resection and stapled anastomosis, 22% with simple oversew, and 11% with resection and hand-sewn anastomosis. Recurrence of ECF was 12% when operation was performed prior to 36 weeks from diagnosis, compared with 36% if performed at or beyond 36 weeks.


CONCLUSIONS
The primary determinant of mortality after ECF repair is a failed operation leading to recurrence of the fistula. Risk factors for ECF recurrence include inflammatory bowel disease, fistula located in the small intestine, an interval of 36 weeks or longer between diagnosis and operation, and resection with stapled anastomosis.
Brenner
Megan
M
Division of General Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, USA.
Clayton
John L
JL
Tillou
Areti
A
Hiatt
Jonathan R
JR
Cryer
H G
HG
D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention