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Management of enterocutaneous fistulae: A 10 years experience
Deepa Taggarshe1, Daniel Bakston, Michael Jacobs
1Deepa 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.
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.
