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.
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: H Alkhatib; L Tastaldi; D M Krpata; C C Petro; M Olson; S Rosenblatt; M J Rosen; A S Prabhu Journal: Hernia Date: 2019-01-09 Impact factor: 4.739
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