title: Enterocutaneous Fistula: Different Surgical Intervention Techniques for Closure along with Comparative Evaluation of Aluminum Paint, Karaya Gum (Hollister) and Gum Acacia for Peristomal Skin Care.
abstract: BACKGROUND
  Gastrointestinal fistulas are serious complications and are associated with high morbidity and mortality rates. In majority of the patients, fistulas are treatable. However, the treatment is very complex and often multiple therapies are required. These highly beneficial treatment options which could shorten fistula closure time also result in considerable hospital cost savings.
  
  
  OBJECTIVE
  This study was planned to study aetiology, clinical presentation, morbidity and mortality of enterocutaneous fistula and to evaluate the different surgical intervention techniques for closure of enterocutaneous fistula along with a comparative evaluation of different techniques for management of peristomal skin with special emphasis on aluminum paint, Karaya gum (Hollister) and Gum Acacia.
  
  
  METHODS
  This prospective observational study was conducted in the Department of Surgery, M.L.N. Medical College, Allahabad and its associated hospital (S.R.N. Hospital, Allahabad) for a period of five years.
  
  
  RESULTS
  Majority of enterocutaneous fistula were of small bowel and medium output fistulas (500-1000 ml/24hours). Most of the patients were treated with conservative treatment as compared to surgical intervention. Large bowel fistula has maximum spontaneous closure rate compare to small bowel and duodenum. Number of orifice whether single or multiple does not appear to play statistically significant role in spontaneous closure of fistula. Serum Albumin is a significantly important predictor of spontaneous fistula closure and mortality. Surgical management appeared to be the treatment of choice in distal bowel fistula. The application of karaya gum (Hollister kit), Gum Acacia and Aluminum Paint gave similar outcome.
  
  
  CONCLUSIONS
  Postoperative fistulas are the most common aetiology of enterocutaneous fistula and various factors do play role in management. Peristomal skin care done with Karaya Gum, Gum Acacia and Aluminum Paint has almost equal efficiency in management of skin excoriation. However, role of Gum Acacia was found to be good with inflamed, excoriated and ulcerative skin in comparison to Aluminum Paint and as efficacious as Karaya Gum but at much lower cost.
authors.affiliation: Senior Resident, Department of Pediatrics Surgery, King George's Medical University , Lucknow, U.P., India .
authors.forename: Piyush
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Senior Resident, Department of Maternal and Reproductive Health, Sanjay Gandhi Post Graduate Institute of Medical Sciences , Lucknow, U.P., India .
authors.lastname: Namrata
authors.affiliation: Professor, Department of General Surgery, Moti Lal Nehru Medical College , Allahabad, U.P., India .
authors.forename: Shabi
authors.initials: S
authors.lastname: Ahmad
keywords: Abdominal trauma; Fistula closure; Peristomal care
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