Guided treatment improves outcome of patients with enterocutaneous fistulas.
BACKGROUND
The present study was designed to evaluate the effects of guided treatment of patients with an enterocutaneous fistula and to evaluate the effect of prolonged period of convalescence on outcome.


METHODS
All consecutive patients with an enterocutaneous fistula treated between 2006 and 2010 were included in this study. Patient information was gathered prospectively. Treatment of patients focused on sepsis control, optimization of nutritional status, wound care, establishing the anatomy of the fistula, timing of surgery, and surgical principles. Outcome included spontaneous and surgical closure, mortality, and postoperative recurrence. The relationship between period of convalescence and recurrence rate was determined by combining the present prospective cohort with a historical cohort from our group.


RESULTS
Between 2006 and 2010, 79 patients underwent focused treatment for enterocutaneous fistula. Cox regression analysis showed that period of convalescence related significantly with recurrence of the fistula (hazard ratio 0.99; 95 % confidence interval 0.98-0.999; p = 0.04). Spontaneous closure occurred in 23 (29 %) patients after a median period of convalescence of 39 (range 7-163) days. Forty-nine patients underwent operative repair after median period of 101 (range 7-374) days and achieved closure in 47 (96 %). Overall, eight patients (10 %) died.


CONCLUSIONS
Prolonging period of convalescence for patients with enterocutaneous fistulas improves spontaneous closure and reduces recurrence rate.
Department of Surgery, Maastricht University Medical Centre, NUTRIM School for Nutrition, Toxicology & Metabolism, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. r.visschers@maastrichtuniversity.nl
Ruben G J
RG
Visschers
Wim G
WG
van Gemert
Bjorn
B
Winkens
Peter B
PB
Soeters
Steven W M
SW
Olde Damink
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult