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World Journal of Surgery

Published in:

01-03-2008

Systematic Management of Postoperative Enterocutaneous Fistulas: Factors Related to Outcomes

Authors: Jose L. Martinez, Enrique Luque-de-Leon, Juan Mier, Roberto Blanco-Benavides, Felipe Robledo

Published in: World Journal of Surgery | Issue 3/2008

Abstract

Background

Most enterocutaneous fistulas are postoperative in origin. Sepsis, malnutrition, and hydroelectrolytic deficit are still the most important complications to which patients with postoperative enterocutaneous fistulas (PEF) are exposed. Knowledge of prognostic factors related to specific outcomes is essential for therapeutic decision-making processes.

Methods

We reviewed files of all consecutive patients with PEF treated in our hospital during a 10-year period. Our aim was to identify factors related to spontaneous closure, need for operative treatment, and mortality. Univariate and multivariate analyses were performed.

Results

A total of 174 patients were treated. The most frequent site of origin was the small bowel (90 patients: 48 jejunal, and 42 ileal), followed in frequency by the colon (50 patients). Postoperative enterocutaneous fistula closure was achieved in 151 patients (86%), being spontaneous in 65 (37%) and surgical in 86 (49%). Factors that significantly precluded spontaneous closure were jejunal site, multiple fistulas, sepsis, high output, and hydroelectrolytic deficit at diagnosis or referral. Origin of PEF at our hospital was the only factor significantly associated with spontaneous closure. The most frequent operative indication was PEF persistence without sepsis. Factors significantly associated with the need for operative treatment were high output, jejunal site, and multiple fistulas. Closure was achieved in 84% of patients who underwent operation. A total of 23 patients died (13%). Factors associated with mortality were serum albumin <3.0 g/dl (at diagnosis or referral), high output, hydroelectrolytic deficit, multiple fistulas, jejunal site, sepsis, and a complex fistulous tract.

Conclusions

In spite of advances in management of PEF, the associated morbidity and mortality remain high. Among several variables influencing outcome, our multivariate analysis disclosed high output, jejunal site, multiple fistulas, and sepsis as independent adverse factors related to non-spontaneous closure, need for operative treatment, and/or death.

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Title: Systematic Management of Postoperative Enterocutaneous Fistulas: Factors Related to Outcomes
Authors: Jose L. Martinez
Enrique Luque-de-Leon
Juan Mier
Roberto Blanco-Benavides
Felipe Robledo
Publication date: 01-03-2008
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 3/2008
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-007-9304-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Systematic Management of Postoperative Enterocutaneous Fistulas: Factors Related to Outcomes

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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