Reduction of the closure time of postoperative enterocutaneous fistulas with fibrin sealant.
OBJECTIVE
To assess whether the use of fibrin sealant shortens the closure time of postoperative enterocutaneous fistulas (ECFs).


METHODS
The prospective case-control study included 70 patients with postoperative ECFs with an output of < 500 mL/d, a fistulous tract of > 2 cm and without any local complication. They were divided into study (n = 23) and control groups (n = 47). Esophageal, gastric and colocutaneous fistulas were monitored under endoscopic visualization, which also allowed fibrin glue application directly through the external hole. Outcome variables included closure time, time to resume oral feeding and morbidity related to nutritional support.


RESULTS
There were no differences in mean age, fistula output, and follow-up. Closure-time for all patients of the study group was 12.5 +/- 14.2 d and 32.5 +/- 17.9 d for the control group (P < 0.001), and morbidity related to nutritional support was 8.6% and 42.5%, respectively (P < 0.01). In patients with colonic fistulas, complete closure occurred 23.5 +/- 19.5 d after the first application of fibrin glue, and spontaneous closure was observed after 36.2 +/- 22.8 d in the control group (P = 0.36). Recurrences were observed in 2 patients because of residual disease. One patient of each group died during follow-up as a consequence of septic complications related to parenteral nutrition.


CONCLUSIONS
Closure time was significantly reduced with the use of fibrin sealant, and oral feeding was resumed faster. We suggest the use of fibrin sealant for the management of stable enterocutaneous fistulas.
Research Unit in Clinical Epidemiology, High Specialized Medical Unit, Mexican Institute of Social Security, José Enrique Rodo #2558, Colonia Prados Providencia, 44670, Guadalajara, Jalisco, Mexico.
Jorge
J
Avalos-González
Eliseo
E
Portilla-deBuen
Caridad Aurea
CA
Leal-Cortés
Abel
A
Orozco-Mosqueda
María del Carmen
Mdel C
Estrada-Aguilar
Gabriela Abigail
GA
Velázquez-Ramírez
Gabriela
G
Ambriz-González
Clotilde
C
Fuentes-Orozco
Aldo Emmerson
AE
Guzmán-Gurrola
Alejandro
A
González-Ojeda
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D007412:Intestinal Fistula / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives