Surgery for high-output small bowel enterocutaneous fistula: a 30-year experience

Area of Science:

• Gastroenterology
• Surgical Innovation
• Clinical Outcomes

Background:

• High-output small bowel enterocutaneous fistula (SBECF) presents significant management challenges.
• Conservative management has limitations, with a notable mortality rate.
• Surgical intervention is often necessary for definitive treatment.

Purpose of the Study:

• To evaluate the efficacy of surgical repair for high-output SBECF.
• To assess the impact of intraluminal stenting as part of the surgical technique.
• To determine the success and complication rates associated with this surgical approach.

Main Methods:

• Retrospective evaluation of 282 patients with high-output SBECF.
• Comparison of conservative management versus surgical treatment.
• Surgical repair involved fistula resection and small bowel stenting in all surgical cases.

Main Results:

• Conservative management yielded an 81.4% spontaneous closure rate but an 18.6% mortality rate.
• Surgical repair, including stenting, achieved a 93.9% success rate with 6% postoperative mortality.
• No complications were reported due to intestinal stenting, and no refistulization or obstruction occurred within 6 months post-surgery.

Conclusions:

• Routine intraluminal stenting should be integrated into the surgical repair of SBECF.
• Surgical repair with stenting offers a high success rate and favorable outcomes for high-output SBECF.
• This technique minimizes complications like refistulization and obstruction.