Timing of Curative Surgery in Postoperative Enterocutaneous Fistulas: A Retrospective Cohort Study of 200 Patients

Evaluate the feasibility of early radical enterocutaneous fistula (ECF) surgery.

After failure of medical treatment for ECF, the optimal timing of surgical reintervention remains debated.

Patients undergoing radical ECF surgery to treat postoperative small bowel- ECFs and/or colon-ECFs (2005-2024) were retrospectively included. Success was defined as no remnant ECF or ECF-related stoma at the most recent follow-up and absence of 90-day postoperative mortality. Early ECF surgery was defined as planned surgery (urgent procedures excluded) occurring within 4 months of the last abdominal procedure.

Among 200 patients (median 62 years; 43% female; 40% American Society of Anesthesiologists ≥ 3), 77% had small bowel-ECF only, 12% colon-ECF only and 11%. both. Eighty-two percent were referred, with a median delay of 48 days [interquartile range (IQR): 8-200] after ECF diagnosis. Referral center management lasted 34 days (IQR: 3-90), with 10% exceeding 120 days. After excluding 22 emergency procedures, early ECF surgery was performed in 39% (70/178). Early-surgery patients had fewer respiratory comorbidities (9% vs 21%; P = 0.036) and shorter ECF diagnosis-to-transfer interval (16 days vs 145; P = 0.001). Early surgery did not impact operative time ( P = 0.312), mortality ( P = 0.091), severe morbidity ( P = 0.867), and reoperations ( P = 0.511). After a median follow-up of 12 months, the success rate was 74% (permanent stomas = 11%; recurrence = 17%). American Society of Anesthesiologists ≥ 3 ( P = 0.012) and malignancies ( P = 0.010) were independently associated with failure on multivariate analysis, whereas ECF-origin ( P = 0.924) and surgical timing ( P = 0.438) were not.

For postoperative small bowel/colon ECF, the success rate of radical surgery is 74%. Early surgery seems feasible (39%) and does not compromise success. Further prospective studies are needed.