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01-08-2021 | Original Article

Management of ventral hernia defect during enterocutaneous fistula takedown: practice patterns and short-term outcomes from the Abdominal Core Health Quality Collaborative

Authors: A. Fafaj, L. Tastaldi, H. Alkhatib, S. J. Zolin, S. Rosenblatt, L.-C. Huang, S. Phillips, D. M. Krpata, A. S. Prabhu, C. C. Petro, M. J. Rosen

Published in: Hernia | Issue 4/2021

Abstract

Background

An enterocutaneous fistula (ECF) with an associated large hernia defect poses a significant challenge for the reconstructive surgeon. We aim to describe operative details and 30-day outcomes of elective hernia repair with an ECF when performed by surgeons participating in the Abdominal Core Health Quality Collaborative (ACHQC).

Study design

Patients undergoing concomitant hernia and ECF elective repair were identified within the ACHQC. Outcomes of interest were operative details and 30-day rates of surgical site infections (SSI), surgical site occurrences requiring procedural intervention (SSOPI), medical complications, and mortality.

Results

170 patients were identified (mean age 60 years, 52.4% females, mean BMI 32.3 kg/m²). 106 patients (62%) had small-bowel ECFs, mostly managed with resection without diversion. 30 patients (18%) had colonic ECFs, which were managed with resection without diversion (14%) or resection with diversion (6%). 100 (59%) had a prior mesh in place, which was removed in 90% of patients. Hernias measured 14 cm ± 7 in width, and 68 (40%) had a myofascial release performed (41 TARs). Mesh was placed in 115 cases (68%), 72% as a sublay, and more frequently of biologic (44%) or permanent synthetic (34%) material. 30-day SSI was 18% (37% superficial, 40% deep), and 30-day SSOPI was 21%. 19 patients (11%) were re-operated: 8 (8%) due to a wound complication and 4 (2%) due to a missed enterotomy. Two infected meshes were removed, one biologic and one synthetic.

Conclusions

Surgeons participating in the ACHQC predominantly resect ECFs and repair the associated hernias with sublay mesh with or without a myofascial release. Morbidity remains high, most closely related to wound complications, as such, concomitant definitive repairs should be entertained with caution.

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Title: Management of ventral hernia defect during enterocutaneous fistula takedown: practice patterns and short-term outcomes from the Abdominal Core Health Quality Collaborative
Authors: A. Fafaj
L. Tastaldi
H. Alkhatib
S. J. Zolin
S. Rosenblatt
L.-C. Huang
S. Phillips
D. M. Krpata
A. S. Prabhu
C. C. Petro
M. J. Rosen
Publication date: 01-08-2021
Publisher: Springer Paris
Published in: Hernia / Issue 4/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-020-02347-8

At a glance: The STEP trials

Springer Medicine

Management of ventral hernia defect during enterocutaneous fistula takedown: practice patterns and short-term outcomes from the Abdominal Core Health Quality Collaborative

Abstract

Background

Study design

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Study design

Results

Conclusions

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