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Reduction of the closure time of postoperative enterocutaneous fistulas with fibrin sealant
Jorge Avalos-González, Eliseo Portilla-deBuen, Caridad Aurea Leal-Cortés, Abel Orozco-Mosqueda, María del Carmen Estrada-Aguilar, Gabriela Abigail Velázquez-Ramírez, Gabriela Ambriz-González, Clotilde Fuentes-Orozco, Aldo Emmerson Guzmán-Gurrola, Alejandro González-Ojeda
Jorge Avalos-González, Abel Orozco-Mosqueda, Gabriela Abigail Velázquez-Ramírez, Clotilde Fuentes-Orozco, Aldo Emmerson Guzmán-Gurrola, Alejandro González-Ojeda, Research Unit in Clinical Epidemiology, High Specialized Medical Unit, Avenida Belisario Domínguez #1000, Colonia Independencia, 44340, Guadalajara, Jalisco, Mexico
Eliseo Portilla-deBuen, Caridad Aurea Leal-Cortés, Surgical Research Division, National Western Medical Center, Avenida Sierra Mojada #800, Colonia Independencia, 44340, Guadalajara, Jalisco, Mexico
María del Carmen Estrada-Aguilar, Department of Surgery, Regional General Hospital #1 of the Mexican Institute for Social Security, Avenida Héroes de Nocupetaro y Nicolás de Regules, Colonia Centro, 58000, Morelia, Michoacán, Mexico
Gabriela Ambriz-González, Department of Pediatric Surgery, Children’s Hospital, National Western Medical Center, Av. Belisario Dominguez #720, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
Author contributions: Avalos-González J, Portilla-deBuen E, Leal-Cortés CA, Ambriz-González G, Guzmán-Gurrola AE, Velázquez-Ramírez GA and González-Ojeda A participated in the protocol design, collection of clinical information, statistical analysis and were involved in editing the manuscript; Avalos-González J, Orozco-Mosqueda A, Estrada-Aguilar MC, Ambriz-González G, Fuentes-Orozco C and González-Ojeda A were involved in the protocol design, identification and inclusion of candidates and performed the fibrin glue applications.
Supported by A Grant from the National Council of Science and Technology, No. Conacyt-SiMorelos 2000-0302003
Correspondence to: Alejandro González-Ojeda, MD, PhD, FACS, Research Unit in Clinical Epidemiology, High Specialized Medical Unit, Mexican Institute of Social Security, José Enrique Rodo #2558, Colonia Prados Providencia, 44670, Guadalajara, Jalisco, Mexico.
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Received: December 2, 2009
Revised: January 21, 2010
Accepted: January 28, 2010
Published online: June 14, 2010
AIM: To assess whether the use of fibrin sealant shortens the closure time of postoperative enterocutaneous fistulas (ECFs).
METHODS: The prospective case-control study included 70 patients with postoperative ECFs with an output of < 500 mL/d, a fistulous tract of > 2 cm and without any local complication. They were divided into study (n = 23) and control groups (n = 47). Esophageal, gastric and colocutaneous fistulas were monitored under endoscopic visualization, which also allowed fibrin glue application directly through the external hole. Outcome variables included closure time, time to resume oral feeding and morbidity related to nutritional support.
RESULTS: There were no differences in mean age, fistula output, and follow-up. Closure-time for all patients of the study group was 12.5 ± 14.2 d and 32.5 ± 17.9 d for the control group (P < 0.001), and morbidity related to nutritional support was 8.6% and 42.5%, respectively (P < 0.01). In patients with colonic fistulas, complete closure occurred 23.5 ± 19.5 d after the first application of fibrin glue, and spontaneous closure was observed after 36.2 ± 22.8 d in the control group (P = 0.36). Recurrences were observed in 2 patients because of residual disease. One patient of each group died during follow-up as a consequence of septic complications related to parenteral nutrition.
CONCLUSION: Closure time was significantly reduced with the use of fibrin sealant, and oral feeding was resumed faster. We suggest the use of fibrin sealant for the management of stable enterocutaneous fistulas.
