BACKGROUND: Inflammatory bowel disease (IBD) patients represent a high-risk group for enterocutaneous fistula (ECF) formation, related to both their disease process and the need for multiple surgeries. Often the abdominal wall is significantly involved with the ECF and requires partial resection. The use of synthetic prosthetic material to reconstruct the abdominal wall after ECF surgery is associated with increased risk of infection and recurrent fistulas. Herein we report the use human acellular dermal matrix (hADM) in the surgical treatment and reconstruction of the abdominal wall in 11 consecutive IBD patients with complex and medically refractory ECF. METHODS: After resection of the involved bowel segment and the overlying abdominal wall, a single sheet of hADM was used to reconstruct the defect. Pre- and perioperative risk factors were reviewed and patients were followed prospectively for a year (360 +/- 118 days). RESULTS: Operative mortality was nil. Three patients (27%) developed subcutaneous seroma and there were 2 cases (18%) of superficial wound infection, all of which resolved with conservative management. The mean length of hospital stay was 13.5 (+/-7.2) days and all patients were tolerating an oral diet at the time of dismissal. There were no recurrences. One patient with Crohn's disease developed a new ECF from a separate bowel site on postoperative day 145, which was treated with the same surgical approach. No further complications have occurred. CONCLUSIONS: Our results indicate that in a high-risk IBD patient population with multiple perioperative risk factors the use of hADM during ECF takedown is an effective and well-tolerated treatment option.
BACKGROUND:Inflammatory bowel disease (IBD) patients represent a high-risk group for enterocutaneous fistula (ECF) formation, related to both their disease process and the need for multiple surgeries. Often the abdominal wall is significantly involved with the ECF and requires partial resection. The use of synthetic prosthetic material to reconstruct the abdominal wall after ECF surgery is associated with increased risk of infection and recurrent fistulas. Herein we report the use human acellular dermal matrix (hADM) in the surgical treatment and reconstruction of the abdominal wall in 11 consecutive IBDpatients with complex and medically refractory ECF. METHODS: After resection of the involved bowel segment and the overlying abdominal wall, a single sheet of hADM was used to reconstruct the defect. Pre- and perioperative risk factors were reviewed and patients were followed prospectively for a year (360 +/- 118 days). RESULTS: Operative mortality was nil. Three patients (27%) developed subcutaneous seroma and there were 2 cases (18%) of superficial wound infection, all of which resolved with conservative management. The mean length of hospital stay was 13.5 (+/-7.2) days and all patients were tolerating an oral diet at the time of dismissal. There were no recurrences. One patient with Crohn's disease developed a new ECF from a separate bowel site on postoperative day 145, which was treated with the same surgical approach. No further complications have occurred. CONCLUSIONS: Our results indicate that in a high-risk IBDpatient population with multiple perioperative risk factors the use of hADM during ECF takedown is an effective and well-tolerated treatment option.
Authors: George Kouklakis; Eleni I Efremidou; Peter Zezos; Nikolaos Liratzopoulos; Vassilios D Souftas; Anthia Gatopoulou; Konstantinos Simopoulos; Konstantinos J Manolas Journal: J Med Case Rep Date: 2011-03-19