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Management of enterocutaneous fistulas: 30-year clinical experience
Jieshou Li1, Jian'an Ren, Weiming Zhu
1Research Institute of General Surgery, General Hospital of Nanjing Command PLA, Nanjing 210002, China.
Objectives:
To explore successful models of management of enterocutaneous fistulas and unresolved problems requiring further study.
Method:
Analysis of therapeutic results of 1168 cases treated in one center from January 1971 to December 2000.
Results:
In this group of patients, the recovery rate was 93% and 37% of fistulas healed spontaneously after non-operative treatment. The mortality rate was 5.5%, most of which occurred due to sepsis. Of 659 cases receiving definitive operations for enteric fistula, 98% recovered. Recovery, mortality and operational success rates (94.2%, 4.4%, 99.7%) of cases treated between January 1985 and December 2000 were significantly better than those (90.4%, 8.2%, 95.5%) of cases treated earlier (January 1971-December 1984) (P < 0.05).
Conclusions:
The results from this study were better overall than those reported in previous literatures. The change in therapeutic strategy, improved technique in control of sepsis, rational nutritional support and careful monitoring of vital organs are the key reasons for improvement of managing enteric fistulas. However, increasing spontaneous closure of fistula, improving the therapeutic rate of specific enteric fistula (IBD or radiation enteritis) and performing definitive operations for enteric fistula at early stages are still problematic and require further study.