BACKGROUND: A review was performed on entero-cutaneous fistula (ECF) repair and early recurrence, adding our twenty adult patients (65% had multiple fistulas). METHODS: The search yielded 4.098 articles but only 15 were relevant: 1.217 patients underwent surgery. The interval time between fistula's diagnosis and operative repair was between 3 months and 1 year. A bowel resection with primary anastomosis was performed in 1.048 patients, 192 (18.3%) underwent a covering stoma: 856 patients (81.7%) had a fistula takedown in one procedure. RESULTS: The patients had 14.3% recurrence and 13.1% mortality rate. In our experience 75% were surgically treated after a period equal or above one year from fistula occurrence: surgery was very demolitive (in 40% remnant small bowel was less than 100 cm). We performed a bowel resection with a hand-sewn anastomosis (95%) without temporary stoma. In-hospital mortality was 0% and at discharge all were back to oral intake with 0% early re-fistulisation. CONCLUSIONS: Literature supports our experience: ECF takedown could be safely performed after an adequate period of recovery from 3 months to one year from fistula occurrence. In our series primary repair (bowel resection plus reconnection surgery without temporary stoma) avoided an early recurrence without mortality.
BACKGROUND: A review was performed on entero-cutaneous fistula (ECF) repair and early recurrence, adding our twenty adult patients (65% had multiple fistulas). METHODS: The search yielded 4.098 articles but only 15 were relevant: 1.217 patients underwent surgery. The interval time between fistula's diagnosis and operative repair was between 3 months and 1 year. A bowel resection with primary anastomosis was performed in 1.048 patients, 192 (18.3%) underwent a covering stoma: 856 patients (81.7%) had a fistula takedown in one procedure. RESULTS: The patients had 14.3% recurrence and 13.1% mortality rate. In our experience 75% were surgically treated after a period equal or above one year from fistula occurrence: surgery was very demolitive (in 40% remnant small bowel was less than 100 cm). We performed a bowel resection with a hand-sewn anastomosis (95%) without temporary stoma. In-hospital mortality was 0% and at discharge all were back to oral intake with 0% early re-fistulisation. CONCLUSIONS: Literature supports our experience: ECF takedown could be safely performed after an adequate period of recovery from 3 months to one year from fistula occurrence. In our series primary repair (bowel resection plus reconnection surgery without temporary stoma) avoided an early recurrence without mortality.
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: R Manta; M Manno; H Bertani; C Barbera; F Pigò; V Mirante; E Longinotti; G Bassotti; R Conigliaro Journal: Endoscopy Date: 2011-03-15 Impact factor: 10.093
Authors: David M Krpata; Sharon L Stein; Michelle Eston; Bridget Ermlich; Jeffrey A Blatnik; Yuri W Novitsky; Michael J Rosen Journal: Am J Surg Date: 2013-01-30 Impact factor: 2.565
Authors: G Lambe; C Russell; C West; R Kalaiselvan; D A J Slade; I D Anderson; J S Watson; G L Carlson Journal: Br J Surg Date: 2012-05-09 Impact factor: 6.939
Authors: A Lauro; A Santoro; R Cirocchi; M Michelini; N Zorzetti; M C Cianci; M I Bellini; C Casadei; M C Ripoli; R Coletta; S Khouzam; I R Marino; V D'Andrea; A Morabito Journal: Updates Surg Date: 2022-07-08