title: Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown.
abstract: BACKGROUND
  The surgical management of enterocutaneous fistulas (ECFs) in the setting of large abdominal wall defects can be challenging. We aimed to review our experience with simultaneous single-stage ECF takedown and complex abdominal wall reconstruction (AWR).
  
  
  METHODS
  Using a prospectively collected database, patients requiring surgical management of an ECF and AWR over a 5-year period were reviewed.
  
  
  RESULTS
  Thirty-seven patients (mean age = 58.6 years) underwent ECF repair/AWR. The mean hernia defect size was 426 ± 192 cm(2). Thirty-five (95%) patients required fascial releases to achieve abdominal wall closure. Thirty-six (97%) patients had sublay biologic mesh placed to reinforce the repair. Twenty-four (65%) patients developed a surgical site infection (8 superficial, 8 deep, and 8 organ space). Four patients developed an early anastomotic leak/refistulization. With a mean follow-up of 20 months, the hernia recurrence rate was 32% (n = 12).
  
  
  CONCLUSIONS
  The simultaneous reconstruction of ECF and complex abdominal wall defects resulted in successful single-stage management of these challenging cases in nearly 70% of patients in this series.
authors: Case Acute Intestinal Failure Unit University Hospitals Case Medical Center, 11100 Euclid Avenue, Mail Stop LKS 5047, Cleveland, OH 44106, USA.
authors: David M
authors: DM
authors: Krpata
authors: Sharon L
authors: SL
authors: Stein
authors: Michelle
authors: M
authors: Eston
authors: Bridget
authors: B
authors: Ermlich
authors: Jeffrey A
authors: JA
authors: Blatnik
authors: Yuri W
authors: YW
authors: Novitsky
authors: Michael J
authors: MJ
authors: Rosen
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D061645:Abdominoplasty / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D000071938:Fasciotomy; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome