Enterocutaneous Fistulas: Current Management

Background: Enterocutaneous fistulas (ECFs) and enteroatmospheric fistulas (EAFs) are rare but highly morbid complications that most commonly arise after abdominal surgery. Outcomes have improved with advances in multidisciplinary care and with increasing research on how to best manage them; however, they remain associated with significant morbidity, high mortality, and prolonged hospitalization. Optimal timing of definitive repair is unknown, with many high-volume centers waiting 6-12 months, though emerging data suggest that earlier intervention may be feasible in carefully selected patients. Given their complexity and variability in management, a comprehensive review of current evidence is needed. Methods: A narrative review of the literature was conducted with emphasis on the classification, pathophysiology, and multidisciplinary management of ECFs and EAFs. Relevant studies addressing fluid and sepsis control, nutritional optimization, wound care, pharmacologic therapies, and interventional strategies were reviewed. Results: The management of ECFs requires a staged approach focused on fluid resuscitation, sepsis control, wound management, and nutritional optimization. Spontaneous closure can occur, and is most commonly within the first two months. Nutritional optimization through enteral and/or parenteral nutrition or fistuloclysis plays a vital role in improving outcomes. Therapies such as negative pressure wound therapy, biologics, and pharmacologic agents may support spontaneous closure and fistula control. In non-healing fistulas, surgical repair remains necessary, with optimal time for surgery at least 6-12 months from fistula development. Conclusions: ECFs and EAFs remain complex surgical challenges. Outcomes have improved due to advances in nutritional support and wound management, and the emergence of minimally invasive techniques. Standardization of treatment protocols and further research into novel therapy may further enhance outcomes and limit variability in management.