Enterocutaneous fistula: are treatments improving?

Area of Science:

• Gastroenterology
• Surgical Oncology
• Critical Care Medicine

Background:

• Enterocutaneous fistulas present significant challenges with historically high mortality (5-20%) and moderate surgical healing rates (75-85%).
• Evaluating current practices and the impact of novel therapies like octreotide, wound vacuum-assisted closure (VAC), and fibrin glue is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the efficacy of octreotide, wound VAC, and fibrin glue in managing enterocutaneous fistulas.
• To evaluate current treatment strategies and their impact on clinical outcomes for enterocutaneous fistula patients.

Main Methods:

• A retrospective review of 106 enterocutaneous fistula cases treated between 1997 and 2005 at two major teaching hospitals.
• Exclusion criteria included patients with irritable bowel disease and anorectal fistulas. Data on fistula origin, etiology, output, and treatment modalities were analyzed.

Main Results:

• The most common origin was the small bowel (67 patients), with previous operations being the primary etiology (81 patients).
• Octreotide showed benefit in fistula output for 8/24 patients; fibrin glue benefited 1/8; wound VAC improved wound care but 12/13 still needed surgery.
• Operative repair was successful in 89% (69/77), while nonoperative management healed 60% (18/29). Overall mortality was 7% (7/106), mainly due to cancer persistence or sepsis.

Conclusions:

• Enterocutaneous fistula remains a significant surgical challenge, with octreotide showing partial response and wound VAC offering adjunctive wound care benefits.
• While novel therapies have shown anecdotal success, a well-timed surgical intervention, alongside sepsis control and nutritional support, is the most effective treatment.
• The study highlights a 7% mortality rate, lower than historical data, but emphasizes the continued importance of surgical management for enterocutaneous fistulas.