BACKGROUND: Enterocutaneous fistulas arise as complications in 0.8%-2% of abdominal operations. The global mortality rate is 5%-37%, yet it may exceed 60% in the case of high-output fistulas and when sepsis and malnutrition are involved. The objective of this prospective cohort study with retrospective data analyses was to analyze our ten-year experience with a vacuum-compaction device for the management of high-output, postoperative enterocutaneous fistulas at the Department of General Surgery, E. Tornú Hospital, and the Intensive Care Unit, Churruca Hospital, Buenos Aires, Argentina. PATIENTS AND METHODS: Ninety-one patients presented 179 fistulas; 73 (69.2%) were men whose mean age was 48 years. Sepsis and malnutrition were present in 66 (72.5%). The mean initial fistula output was 1,485 ml/day. Conservative management was carried out according to diagnostic and therapeutic priority staging. A vacuum-compaction system (SIVACO; Spanish acronym) was used to control output. RESULTS: Output was entirely suppressed in 37 (40.7%) patients after 1-7 days of treatment, and reduced to less than 500 ml/day (average=138) in 52 (57.1%) patients. Spontaneous closure was achieved in 42 (46.2%) patients, whereas 37 (40.7%) patients did not improve after 20-380 (average=111) days of treatment. Those patients required surgical correction, which had an 83.8% success rate. Overall mortality was 16.5% (15 patients). CONCLUSIONS: The vacuum-compaction device proved effective for reducing fistula output in 89 of 91 patients (97.8%).
BACKGROUND: Enterocutaneous fistulas arise as complications in 0.8%-2% of abdominal operations. The global mortality rate is 5%-37%, yet it may exceed 60% in the case of high-output fistulas and when sepsis and malnutrition are involved. The objective of this prospective cohort study with retrospective data analyses was to analyze our ten-year experience with a vacuum-compaction device for the management of high-output, postoperative enterocutaneous fistulas at the Department of General Surgery, E. Tornú Hospital, and the Intensive Care Unit, Churruca Hospital, Buenos Aires, Argentina. PATIENTS AND METHODS: Ninety-one patients presented 179 fistulas; 73 (69.2%) were men whose mean age was 48 years. Sepsis and malnutrition were present in 66 (72.5%). The mean initial fistula output was 1,485 ml/day. Conservative management was carried out according to diagnostic and therapeutic priority staging. A vacuum-compaction system (SIVACO; Spanish acronym) was used to control output. RESULTS: Output was entirely suppressed in 37 (40.7%) patients after 1-7 days of treatment, and reduced to less than 500 ml/day (average=138) in 52 (57.1%) patients. Spontaneous closure was achieved in 42 (46.2%) patients, whereas 37 (40.7%) patients did not improve after 20-380 (average=111) days of treatment. Those patients required surgical correction, which had an 83.8% success rate. Overall mortality was 16.5% (15 patients). CONCLUSIONS: The vacuum-compaction device proved effective for reducing fistula output in 89 of 91 patients (97.8%).
Authors: Jose L Martinez; Enrique Luque-de-León; Guillermo Ballinas-Oseguera; José D Mendez; Marco A Juárez-Oropeza; Ruben Román-Ramos Journal: J Gastrointest Surg Date: 2011-10-15 Impact factor: 3.452
Authors: Mona Baharestani; Ibrahim Amjad; Kim Bookout; Tatjana Fleck; Allen Gabriel; David Kaufman; Shannon Stone McCord; Donald C Moores; Oluyinka O Olutoye; Jorge D Salazar; David H Song; Steven Teich; Subhas Gupta Journal: Int Wound J Date: 2009-08 Impact factor: 3.315