Effect of Preoperative Administration of Oral Arginine and Glutamine in Patients with Enterocutaneous Fistula Submitted to Definitive Surgery: a Prospective Randomized Trial

  • Jose L. Martinez
  • Ilka Bosco-Garate
  • Luis Manuel Souza-Gallardo
  • José D. Méndez
  • Marco A. Juárez-Oropeza
  • Ruben Román-Ramos
  • Eduardo Ferat-OsorioEmail author
Original Article



The use of glutamine and arginine has shown several advantages in postoperative outcomes in patients after gastrointestinal surgery. We determined the effects of its use in patients with enterocutaneous fistula after operative treatment.

Patients and Methods

Forty patients with enterocutaneous fistula were randomly assigned to one of two groups. The control group received the standard medical care while the patients of the experimental group were supplemented with enteral administration of 4.5 g of arginine and 10 g of glutamine per day for 7 days prior to the surgery. The primary outcome variable was the recurrence of the fistula and the secondary outcomes were preoperative and postoperative serum concentrations of interleukin 6 and C-reactive protein and postoperative infectious complications.


Twenty patients were assigned to each group. The fistula recurred in two patients (10%) of the experimental group and in nine patients (45%) of the control group (P < 0.001). We found a total of 13 infectious complications in six patients of the control group (all with fistula recurrence) and none in the experimental group. Mean preoperative serum concentrations of interleukin 6 and C-reactive protein were lower in patients from the experimental group. In addition, these levels were lower in patients who had recurrence if compared to patients that did not recur.


Preoperative administration of oral arginine and glutamine could be valuable in the postoperative recovery of patients with enterocutaneous fistulas submitted to definitive surgery.


Intestinal fistula Postoperative complications Glutamine Arginine 


Author Contributions

Study conception and design: Martinez, Mendez, Roman, Juarez, Ferat

Acquisition of data: Martinez, Bosco, Souza, Ferat

Analysis and interpretation of data: Martinez, Bosco, Souza, Mendez, Roman, Juarez, Ferat

Drafting of manuscript: Martinez, Souza, Ferat

Critical revision: Martinez, Bosco, Souza, Mendez, Juarez, Roman, Ferat

Final approval: Martinez, Bosco, Souza, Mendez, Juarez, Roman, Ferat

All authors (Martinez, Bosco, Souza, Mendez, Juarez, Roman, Ferat) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

Compliance with Ethical Standards

The study was reviewed and approved by the Hospital de Especialidades de Centro Medico Nacional SXXI Institutional Review Board (R-2010-3601-98).

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Jose L. Martinez
    • 1
    • 2
  • Ilka Bosco-Garate
    • 3
  • Luis Manuel Souza-Gallardo
    • 1
  • José D. Méndez
    • 4
  • Marco A. Juárez-Oropeza
    • 5
  • Ruben Román-Ramos
    • 6
  • Eduardo Ferat-Osorio
    • 1
    • 3
    Email author
  1. 1.Department of General and Gastrointestinal SurgeryUMAE Hospital de Especialidades – Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS)Mexico CityMexico
  2. 2.Programa de Doctorado en Ciencias BiológicasUniversidad Autónoma Metropolitana-IztapalapaMexico CityMexico
  3. 3.Unidad de Investigación Médica en InmunoquímicaUMAE Hospital de Especialidades – Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS)Mexico CityMexico
  4. 4.Unidad de Investigación Médica en Enfermedades MetabólicasUMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS)Mexico CityMexico
  5. 5.Facultad de MedicinaUniversidad Nacional Autónoma de MéxicoMexico CityMexico
  6. 6.División Ciencias Biológicas y de la SaludUniversidad Autónoma Metropolitana-IztapalapaMexico CityMexico

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