Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastrointest Surg. Jul 27, 2010; 2(7): 242-246
Published online Jul 27, 2010. doi: 10.4240/wjgs.v2.i7.242
Management of enterocutaneous fistulae: A 10 years experience
Deepa Taggarshe, Daniel Bakston, Michael Jacobs, Alasdair McKendrick, Vijay K Mittal
Deepa Taggarshe, Daniel Bakston, Michael Jacobs, Alasdair McKendrick, Vijay K Mittal, Department of Surgery, Providence Hospital and Medical Centers, 16001 West Nine Mile Road, Southfield, MI 48075, United States
Author contributions: Taggarshe D, Bakston D and Jacobs M performed the literature review, acquisition of data, and manuscript preparation; McKendrick A and Mittal VK contributed to the concept of this study and performed manuscript review; Mittal VK was also responsible for supervision.
Correspondence to: Vijay K Mittal, MD, FACS, Department of Surgery, Providence Hospital and Medical Centers, 16001 West Nine Mile Road, Southfield, MI 48075, United States. vijay.mittal@providence-stjohnhealth.org
Telephone: +1-248-8498902 Fax: +1-248-8495380
Received: March 1, 2010
Revised: July 13, 2010
Accepted: July 20, 2010
Published online: July 27, 2010
Abstract

AIM: To compare the outcomes of conservative vs surgical treatment of enterocutaneous fistulae (ECF) in a community teaching hospital over a decade.

METHODS: All cases of ECF between 1997 and 2007 were reviewed for management strategy.

RESULTS: Of the 83 patients with ECF, 60 (72%) were postoperative. Sixty-six patients (79.5%) were treated initially with conservative measures. Eighteen patients failed to respond to conservative treatment and required later (secondary) exploration; this group consisted of an equal number of low vs high output fistulae. Seventeen (20.5%) patients underwent initial (primary) definitive-surgery secondary to anastomotic leak and peritonitis. Surgical procedures included resection of ECF with anastomosis (24), exclusion (6) and direct-drainage (4). No significant difference was seen in the recurrence rate for conservative (10%) vs operative-treatment (20%).

CONCLUSION: Conservative treatment plays a pivotal role as an initial management in both low and high output fistulae. In selective cases only, early primary exploration is recommended.

Keywords: Low-output; High-output; Enterocutaneous fistulae