Top

Published in:

Open Access 01-03-2018 | Original Scientific Report

A Systematic Review and Meta-analysis of Timing and Outcome of Intestinal Failure Surgery in Patients with Enteric Fistula

Authors: Fleur E. E. de Vries, Jasper J. Atema, Oddeke van Ruler, Carolynne J. Vaizey, Mireille J. Serlie, Marja A. Boermeester

Published in: World Journal of Surgery | Issue 3/2018

Abstract

Background

The timing of intestinal failure (IF) surgery has changed. Most specialized centers now recommend postponing reconstructive surgery for enteric fistula and emphasize that abdominal sepsis has to be resolved and the patient’s condition improved. Our aim was to study the outcome of postponed surgery, to identify risk factors for recurrence and mortality, and to define more precisely the optimal timing of reconstructive surgery.

Methods

PubMed, Embase, and the Cochrane Library were systematically reviewed on the outcomes of reconstructive IF surgery (fistula recurrence, mortality, morbidity, hernia recurrence, total closure, enteral autonomy). If appropriate, meta-analyses were performed. Optimal timing was explored, and risk factors for recurrence and mortality were identified.

Results

Fifteen studies were included. The weighted pooled fistula recurrence rate was 19% (95% CI 15–24). Lower recurrence rates were found in studies with a longer median time and/or, at the minimum of the range, a longer time interval to surgery. Overall mortality was 3% (95% CI 2–5). Total fistula closure rates ranged from 80 to 97%. Enteral autonomy after reconstructive surgery, mentioned in four studies, varied between 79 and 100%.

Conclusions

Postponed IF surgery for enteric fistula is associated with lower recurrence. Due to the wide range of time to definitive surgery within each study, optimal timing of surgery could not be defined from published data.

Available only for authorised users

Lloyd DA, Gabe SM, Windsor AC (2006) Nutrition and management of enterocutaneous fistula. Br J Surg 9:1045–1055CrossRef

ESCP Intentinal Failure Group, Vaizey CJ, Maeda Y, Barbosa E et al (2016) ESCP consensus on the surgical management of intestinal failure in adults. Color Dis 18:535–548CrossRef

Hill GL (1983) Operative strategy in the treatment of enterocutaneous fistulas. World J Surg 7:495–501CrossRefPubMed

Fisher JE (1983) The pathophysiology of enterocutaneous fistulas. World J Surg 7:446–450CrossRef

Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther 89:873–880PubMed

Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012CrossRefPubMed

Carlson G, Gardiner K, McKee R, et al (2010) The surgical management of patients with acute intestinal failure. Association of Surgeons of Great Britain and Ireland

Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (Minors): development and validation of a new instrument. ANZ J Surg 73:712–716CrossRefPubMed

Sriussadaporn S, Sriussadaporn S, Kritayakirana K et al (2006) Operative management of small bowel fistulae associated with open abdomen. Asian J Surg 29:1–7CrossRefPubMed

10.

Dionigi G, Dionigi R, Rovera F et al (2008) Treatment of high output entero-cutaneous fistulae associated with large abdominal wall defects: single center experience. Int J Surg 6:51–56CrossRefPubMed

11.

Wind J, van Koperen PJ, Slors JF et al (2009) Single-stage closure of enterocutaneous fistula and stomas in the presence of large abdominal wall defects using the components separation technique. Am J Surg 197:24–29CrossRefPubMed

12.

Gyorki DE, Brooks CE, Gett R et al (2010) Enterocutaneous fistula: a single-centre experience. ANZ J Surg 80:178–181CrossRefPubMed

13.

Murphy J, Hotouras A, Koers L et al (2013) Establishing a regional enterocutaneous fistula service: the Royal London hospital experience. Int J Surg 11:952–956CrossRefPubMed

14.

Singh B, Haffejee AA, Allopi L et al (2009) Surgery for high-output small bowel enterocutaneous fistula: a 30-year experience. Int Surg 94:262–268PubMed

15.

Visschers RG, Olde Damink SW, Winkens B et al (2008) Treatment strategies in 135 consecutive patients with enterocutaneous fistulas. World J Surg 32:445–453CrossRefPubMedPubMedCentral

16.

Visschers RG, Van Gemert WG, Winken B (2012) Guided treatment improves outcome of patients with enterocutaneous fistulas. World J Surg 36:2341–2348CrossRefPubMedPubMedCentral

17.

Mawdsley JE, Hollington P, Bassett P et al (2008) An analysis of predictive factors for healing and mortality in patients with enterocutaneous fistulas. Aliment Pharmacol Ther 28:1111–1121CrossRefPubMed

18.

Hollington P, Mawdsley JE, Lim W et al (2004) An 11-year experience of enterocutaneous fistula. Br J Surg 91:1646–1651CrossRefPubMed

19.

Runström B, Hallböök O, Nyström PO et al (2013) Outcome of 132 consecutive reconstructive operations for intestinal fistula—staged operation without primary anastomosis improved outcome in retrospective analysis. Scand J Surg 102:152–157CrossRefPubMed

20.

Li J, Ren J, Zhu W et al (2003) Management of enterocutaneous fistulas: 30-year clinical experience. Chin Med J 116:171–175PubMed

21.

Ren J, Yuan Y, Zhao Y et al (2014) Open abdomen treatment for septic patients with gastrointestinal fistula: from fistula control to definitive closure. Am Surg 80:339–347PubMed

22.

Schildberg CW, Raptis D, Langheinrich M et al (2016) Results of surgical and conservative treatment for enterocutaneous fistulas. Is there an indication for conservative treatment? Zentralbl Chir 141:210–214PubMed

23.

Lynch AC, Delaney CP, Senagore AJ et al (2004) Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery. Ann Surg 240:825–831CrossRefPubMedPubMedCentral

24.

Brenner M, Clayton JL, Tillou A et al (2009) Risk factors for recurrence after repair of enterocutaneous fistula. Arch Surg 144:500–505CrossRefPubMed

25.

Owen RM, Love TP, Perez SD et al (2013) Definitive surgical treatment of enterocutaneous fistula: outcomes of a 23-year experience. JAMA Surg 148:118–126CrossRefPubMed

26.

Rahbour G, Gabe SM, Ullah MR et al (2013) Seven-year experience of enterocutaneous fistula with univariate and multivariate analysis of factors associated with healing: development of a validated scoring system. Colorectal Dis 15:1162–1170PubMed

27.

Ravindran P, Ansari N, Young CJ et al (2014) Definitive surgical closure of enterocutaneous fistula: outcome and factors predictive of increased postoperative morbidity. Colorectal Dis 16:209–218CrossRefPubMed

28.

Slater NJ, Bokkerink WJ, Konijn V et al (2014) Safety and durability of 1-stage repair of abdominal wall defects with enteric fistulas. Ann Surg 261:553–557CrossRef

29.

Atema JJ, Mirck B, Van Arum I et al (2016) Outcome of acute intestinal failure. Br J Surg 103:701–708CrossRefPubMed

30.

Wainstein DE, Sisco P, Deforel ML et al (2016) Systematic and specific treatment of patients with enteroatmospheric fistulas: from initial conservative treatment to definitive surgery. Surg Technol Int 28:73–81PubMed

31.

Connolly PT, Teubner A, Lees NP et al (2008) Outcome of reconstructive surgery for intestinal fistula in the open abdomen. Ann Surg 247:440–444CrossRefPubMed

32.

Datta V, Engledow A, Chan S et al (2010) The management of enterocutaneous fistula in a regional unit in the United Kingdom: a prospective study. Dis Colon Rectum 53:192–199CrossRefPubMed

33.

Krpata DM, Stein SL, Eston M et al (2013) Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown. Am J Surg 205:354–358CrossRefPubMed

34.

Martinez JL, Luque-de-Leon E, Ballinas-Oseguera G et al (2012) Factors predictive of recurrence and mortality after surgical repair of enterocutaneous fistula. J Gastrointest Surg 16:156–163CrossRefPubMed

35.

Martinez JL, Luque-de-León E, Ferat-Osorio E et al (2016) Predictive value of preoperative serum C-reactive protein for recurrence after definitive surgical repair of enterocutaneous fistula. Am J Surg 213:105–111CrossRefPubMed

36.

MacFayden BV, Dudrick SJ, Ruberg RL (1973) Management of gastrointestinal fistulas with parenteral hyperalimentation. Surgery 74:100–105

37.

Coutsoftides T, Fazio VW (1979) Small intestine cutaneous fistulas. Surg Gynecol Obstet 149:333–336PubMed

38.

Reber HA, Roberts C, Way LW et al (1978) Management of external gastrointestinal fistulas. Ann Surg 188:460–467CrossRefPubMedPubMedCentral

39.

McIntyre PB, Ritchie JK, Hawley PR et al (1984) Management of enterocutaneous fistulas: a review of 132 cases. Br J Surg 71:293–296CrossRefPubMed

Title: A Systematic Review and Meta-analysis of Timing and Outcome of Intestinal Failure Surgery in Patients with Enteric Fistula
Authors: Fleur E. E. de Vries
Jasper J. Atema
Oddeke van Ruler
Carolynne J. Vaizey
Mireille J. Serlie
Marja A. Boermeester
Publication date: 01-03-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 3/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-4224-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A Systematic Review and Meta-analysis of Timing and Outcome of Intestinal Failure Surgery in Patients with Enteric Fistula

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2018

Mortality and Morbidity After Hartmann’s Procedure Versus Primary Anastomosis Without a Diverting Stoma for Colorectal Perforation: A Nationwide Observational Study

Preoperative Albumin–Bilirubin Grade Predicts Recurrences After Radical Gastrectomy in Patients with pT2-4 Gastric Cancer

Minimally Invasive Pancreaticoduodenectomy: What is the Best “Choice”? A Systematic Review and Network Meta-analysis of Non-randomized Comparative Studies

Prognostic and Predictive Clinicopathologic Factors of Squamous Anal Canal Cancer in HIV-Positive and HIV-Negative Patients: Does HAART Influence Outcomes?

Overall Survival of Papillary Thyroid Carcinoma Patients: A Single-Institution Long-Term Follow-Up of 5897 Patients

Impact of Drain Insertion After Perforated Peptic Ulcer Repair in a Japanese Nationwide Database Analysis