Published in:
01-03-2008
Treatment of High-output Enterocutaneous Fistulas with a Vacuum-compaction Device. A Ten-year Experience
Published in: World Journal of Surgery | Issue 3/2008
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Background
Enterocutaneous fistulas arise as complications in 0.8%–2% of abdominal operations. The global mortality rate is 5%–37%, yet it may exceed 60% in the case of high-output fistulas and when sepsis and malnutrition are involved. The objective of this prospective cohort study with retrospective data analyses was to analyze our ten-year experience with a vacuum-compaction device for the management of high-output, postoperative enterocutaneous fistulas at the Department of General Surgery, E. Tornú Hospital, and the Intensive Care Unit, Churruca Hospital, Buenos Aires, Argentina.
Patients and methods
Ninety-one patients presented 179 fistulas; 73 (69.2%) were men whose mean age was 48 years. Sepsis and malnutrition were present in 66 (72.5%). The mean initial fistula output was 1,485 ml/day. Conservative management was carried out according to diagnostic and therapeutic priority staging. A vacuum-compaction system (SIVACO; Spanish acronym) was used to control output.
Results
Output was entirely suppressed in 37 (40.7%) patients after 1–7 days of treatment, and reduced to less than 500 ml/day (average = 138) in 52 (57.1%) patients. Spontaneous closure was achieved in 42 (46.2%) patients, whereas 37 (40.7%) patients did not improve after 20–380 (average = 111) days of treatment. Those patients required surgical correction, which had an 83.8% success rate. Overall mortality was 16.5% (15 patients).
Conclusions
The vacuum-compaction device proved effective for reducing fistula output in 89 of 91 patients (97.8%).