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Treatment of enterocutaneous fistula: a systematic review and meta-analysis

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Abstract

Background

Enterocutaneous fistula (ECF) is an abnormal communication between the gastrointestinal tract and skin, with a myriad of etiologies and therapeutic options. Management is influenced by etiology and specifics of the ECF, and patient-related factors. The aim of this study was to assess overall success, recurrence, and mortality rates of treatment for ECF.

Materials

A systematic search of PubMed and Google Scholar was performed through October 2021 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Case reports, reviews, animal studies, studies not reporting outcomes, had no available English text, included patients < 16 years old or those assessing other abdominocutaneous/internal fistulas were excluded.

Results

Fifty-three studies, between 1975 and 2020, incorporating 3078 patients were included. Patient age ranged between 16 and 87 years with a male:female ratio of 1.14:1. ECF developed postoperatively in 89.4%. Other common etiologies were inflammatory bowel disease, trauma, malignancy, and radiation. At least 28% of patients had complex fistulae (reported in 18 studies). Most common fistula site was small bowel. In 34 publications, 62.4% (n = 1371) patients received parenteral nutrition. In 45 publications, 72.5% underwent surgery to treat the fistula. Meta-analysis revealed an 89% healing rate; recurrence rate after initial successful treatment was 11.1%, and mortality rate was 8.5%. In a subgroup of patients who underwent combined ECF takedown and abdominal wall reconstructions (n = 315), 78% achieved fascial closure, mesh was used in 72%, hernia, and fistula recurrence rates were 19.7% and 7.6%, respectively.

Conclusions

Treatment of ECF must be individualized according to specific etiology and location of the fistula and the patient’s associated conditions.

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Authors and Affiliations

  1. Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA

    R. Gefen, Z. Garoufalia, P. Zhou, K. Watson, S. H. Emile & S. D. Wexner

  2. Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt

    S. H. Emile

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  1. R. Gefen
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  2. Z. Garoufalia
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  3. P. Zhou
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  4. K. Watson
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Correspondence to S. D. Wexner.

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Conflict of interest

None of the authors report any relevant financial disclosures. Non-relevant financial disclosures: SDW receives consulting fees from ICON Language Services, Intuitive Surgical, Stryker, Medtronic, Takeda, ARC/Corvus, Astellas, Baxter, Olympus, AISChannel, Livsmed, GI Supply, Leading BioSciences, has stock options in Regentys, LifeBond, Pragma/GibLib, Renew Medical and receives royalties from Medtronic, Intuitive Surgical, Karl Storz Endoscopy America Inc, Unique Surgical Innovations LLC.

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Ethical and Informed Consent Statement Based on the nature of the study and that no human subjects were involved, patient consent was not required and this study was deemed exempted from ethics approval based on our institutional Institutional Review Board (IRB) guidelines.

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Gefen, R., Garoufalia, Z., Zhou, P. et al. Treatment of enterocutaneous fistula: a systematic review and meta-analysis. Tech Coloproctol 26, 863–874 (2022). https://doi.org/10.1007/s10151-022-02656-3

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