Outcomes after repair of enterocutaneous fistulas at a specialized center

Enterocutaneous fistula (ECF) is a serious condition that can be challenging to treat with high recurrence and mortality rates. This study reports the characteristics and outcomes of a large series of patients with ECF, aiming at evaluating the rate and factors associated with successful surgical management.

Data were obtained from a prospectively maintained database at an academic institution. All patients who underwent repair of an ECF between 2013 and 2025 were included. Clinical characteristics, operative details, and postoperative outcomes were evaluated. Primary outcomes were fistula recurrence and mortality. Secondary outcomes were intra- and postoperative complications. Regression analysis was used to identify independent risk factors for the primary outcomes.

A total of 93 patients (52% female) underwent surgery with a median age of 58 years (IQR, 44.2-66.6) and a body mass index (BMI) of 23.4 kg/m² (IQR, 20.4-27.8). The proximate cause of fistula formation was spontaneous in 12 patients (13%), whereas the remainder were postoperative; 16 patients (17%) had underlying Crohn's disease. Twenty-two patients (24%) had a recurrence; hence, 76% had a successful repair. The median time to fistula recurrence was 85 days (IQR, 53-372). Mortality occurred in 5 patients (5%). The most common postoperative complications were intra-abdominal or pelvic abscess (19%) and transfusion (28%). Patients with fistula recurrence, compared with patients with no recurrence, had similar age, BMI, etiology (inflammatory bowel disease [IBD] vs non-IBD), American Society of Anesthesiologists class, sex, race, and comorbidities. A significantly longer length of stay was observed in the recurrence group (18.5 vs 8 days; P < .01). Postoperative complications were similar except for anastomotic leak, which was higher in the recurrence group (22.7% vs 7.0%; P = .053). In the multivariable logistic regression analysis, recurrence was independently associated with high-output fistula (odds ratio [OR], 6.62; 95% CI, 1.38-31.80; P = .018), preoperative stoma use (OR, 4.36; 95% CI, 1.17-16.27; P = .029), wound class overall (P = .015), primary repair (OR, 4.55; 95% CI, 1.10-18.85; P = .037), and intraoperative transfusion (OR, 7.72; 95% CI, 1.46-40.74; P = .016).

Surgery for ECF can be accomplished with good rates of healing in experienced centers. Recurrence seems to be associated with fistula severity, operative complexity, and intraoperative burden, underscoring the importance of careful patient optimization and meticulous operative management.