title: Safety and durability of one-stage repair of abdominal wall defects with enteric fistulas.
abstract: OBJECTIVE
  To evaluate the safety and long-term durability of 1-stage repair of enteric fistulas in the presence of an abdominal wall defect.
  
  
  BACKGROUND
  Patients with enteric fistulas and an abdominal wall defect present an extreme challenge to surgeons and have been associated with significant morbidity and mortality. Durability of repair is unknown as studies fail to report this or use limited follow-up periods.
  
  
  METHODS
  Chart review was done of consecutive patients who underwent 1-stage repair. Short-term outcomes included morbidity (wound and medical) and mortality. Long-term durability of repair was determined by prospective outpatient follow-up at least 3 years after surgery.
  
  
  RESULTS
  Thirty-nine patients were included with a mean age of 61.2 years, a mean BMI of 24.4 kg/m2, and a mean abdominal wall defect size of 247.9 cm2. Component separation technique was used in 34 (87.2%) and synthetic mesh in 13 (33.3%) patients. There was 1 (2.6%) postoperative death. Twenty-four wound complications developed in 18 (46.2%) patients, including surgical-site infection in 8 (20.5%) patients. Two (5.1%) enteric fistulas recurred and were treated conservatively resulting in closure. Medical complications were seen 36 times in 23 (59%) patients. Twelve of 33 (36.4%) living patients developed a recurrent hernia after a mean follow-up of 62.7 months (range: 36-130).
  
  
  CONCLUSIONS
  One-stage abdominal wall reconstruction with enteric fistula takedown is feasible at the cost of considerable morbidity. Our treatment strategy including component separation technique with synthetic mesh on-demand results in a durable repair in 6 to 7 of 10 patients.
authors.affiliation: From the Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Slater
authors.forename: Willem J V
authors.initials: WJ
authors.lastname: Bokkerink
authors.forename: Vincent
authors.initials: V
authors.lastname: Konijn
authors.forename: Robert P
authors.initials: RP
authors.lastname: Bleichrodt
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome