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The Importance of Abdominal Wall Closure After Definitive Surgery for Enterocutaneous Fistula

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Abstract

Introduction

The coexistence of an enterocutaneous fistula (ECF) with large abdominal wall defects represent one of the most demanding situations seen by a surgeon. Simultaneous treatment of ECF closure with abdominal wall defect closure has been widely debated. Our objective was to determine if the type of abdominal wall closure was associated with fistula recurrence after definitive surgery for ECF.

Materials and methods

Consecutive patients submitted to fistula resection with primary anastomosis for ECF closure. Among several variables, total abdominal wall closure (primary independent variable) was assessed as a factor related to the recurrence of the ECF (dependent variable). Univariate and multivariate analyses were performed.

Results

One-hundred and fourteen patients were included. Fistula recurred in 39 patients (34%). Total abdominal wall closure was done in 37 patients (32%). ECF recurred in 16% (6 of 37 patients) when abdominal wall closure was performed, compared to 43% (33 of 77 patients) when this was not (p < 0.02). After multivariate analyses, abdominal wall closure was found as a protective factor against recurrence (p < 0.02). Patients with total abdominal wall closure had one-fourth of risk for recurrence compared to patients without it. Other factors associated to recurrence of ECF were multiple fistulas (p < 0.05), intraoperative blood loss >325 mL (p < 0.05) and preoperative C-reactive protein >0.5 mg/dL (p < 0.01).

Conclusion

Our results suggest that total abdominal wall closure is a protective factor against fistula recurrence after definitive surgery for ECF.

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References

  1. Schecter WP, Ivatury RR, Rotondo MF, Hirshberg A (2006) Open abdomen after trauma and abdominal sepsis: a strategy for management. J Am Coll Surg 203(3):390–396

    Article  Google Scholar 

  2. Ivatury RR, Nallathambi M, Rao PM, Rohman M, Stahl WM (1989) Open management of the septic abdomen: therapeutic and prognostic considerations based on APACHE II. Crit Care Med 17(6):511–517

    Article  CAS  Google Scholar 

  3. Björck M, D’Amours SK, Hamilton AER (2011) Closure of the open abdomen. Am Surg 77(Suppl 1):S58–61

    PubMed  Google Scholar 

  4. Ventral Hernia Working Group, Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558

    Article  Google Scholar 

  5. Sriussadaporn S, Sriussadaporn S, Kritayakirana K, Pak-art R (2006) Operative management of small bowel fistulae associated with open abdomen. Asian J Surg 29(1):1–7

    Article  Google Scholar 

  6. Fischer PE, Fabian TC, Magnotti LJ, Schroeppel TJ, Bee TK, Maish GO et al (2009) A ten-year review of enterocutaneous fistulas after laparotomy for trauma. J Trauma 67(5):924–928

    Article  Google Scholar 

  7. Slade DAJ, Carlson GL (2013) Takedown of enterocutaneous fistula and complex abdominal wall reconstruction. Surg Clin North Am 93(5):1163–1183

    Article  Google Scholar 

  8. Martinez JL, Luque-de-León E, Ballinas-Oseguera G, Mendez JD, Juárez-Oropeza MA, Román-Ramos R (2012) Factors predictive of recurrence and mortality after surgical repair of enterocutaneous fistula. J Gastrointest Surg 16(1):156–63 Discussion 163–164

    Article  Google Scholar 

  9. Dionigi G, Dionigi R, Rovera F, Boni L, Padalino P, Minoja G et al (2008) Treatment of high output entero-cutaneous fistulae associated with large abdominal wall defects: single center experience. Int J Surg 6(1):51–56

    Article  CAS  Google Scholar 

  10. Hill GL (1983) Operative strategy in the treatment of enterocutaneous fistulas. World J Surg 7(4):495–501. https://doi.org/10.1007/BF01655939

    Article  CAS  PubMed  Google Scholar 

  11. Visschers RGJ, van Gemert WG, Winkens B, Soeters PB, Olde Damink SWM (2012) Guided treatment improves outcome of patients with enterocutaneous fistulas. World J Surg 36(10):2341–2348. https://doi.org/10.1007/s00268-012-1663-4

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wainstein DE, Fernandez E, Gonzalez D, Chara O, Berkowski D (2008) Treatment of high-output enterocutaneous fistulas with a vacuum-compaction device. A ten-year experience. World J Surg 32(3):430–435. https://doi.org/10.1007/s00268-007-9235-8

    Article  PubMed  Google Scholar 

  13. Connolly PT, Teubner A, Lees NP, Anderson ID, Scott NA, Carlson GL (2008) Outcome of reconstructive surgery for intestinal fistula in the open abdomen. Ann Surg 247(3):440–444

    Article  Google Scholar 

  14. Owen RM, Love TP, Perez SD, Srinivasan JK, Sharma J, Pollock JD et al (2013) Definitive surgical treatment of enterocutaneous fistula: outcomes of a 23-year experience. JAMA Surg 148(2):118–126

    Article  Google Scholar 

  15. Slater NJ, Bokkerink WJV, Konijn V, Bleichrodt RP, van Goor H (2015) Safety and durability of one-stage repair of abdominal wall defects with enteric fistulas. Ann Surg 261(3):553–557

    Article  Google Scholar 

  16. Wind J, van Koperen PJ, Slors JFM, Bemelman WA (2009) Single-stage closure of enterocutaneous fistula and stomas in the presence of large abdominal wall defects using the components separation technique. Am J Surg 197(1):24–29

    Article  Google Scholar 

  17. Fischer JE (2009) The importance of reconstruction of the abdominal wall after gastrointestinal fistula closure. Am J Surg 197(1):131–132

    Article  Google Scholar 

  18. Krpata DM, Stein SL, Eston M, Ermlich B, Blatnik JA, Novitsky YW et al (2013) Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown. Am J Surg 205(3):354–358 Discussion 358–359

    Article  Google Scholar 

  19. Hodgkinson JD, Maeda Y, Leo CA, Warusavitarne J, Vaizey CJ (2017) Complex abdominal wall reconstruction in the setting of active infection and contamination: a systematic review of hernia and fistula recurrence rates. Colorectal Dis 19(4):319–330

    Article  CAS  Google Scholar 

  20. Osborn C, Fischer JE (2009) How I do it: gastrointestinal cutaneous fistulas. J Gastrointest Surg 13(11):2068–2073

    Article  Google Scholar 

  21. Johnson EK, Tushoski PL (2010) Abdominal wall reconstruction in patients with digestive tract fistulas. Clin Colon Rectal Surg 23(3):195–208

    Article  Google Scholar 

  22. Jernigan TW, Fabian TC, Croce MA, Moore N, Pritchard FE, Minard G et al (2003) Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg 238(3):349–355 Discussion 355–357

    Article  Google Scholar 

  23. Baker S, Millard DR (1995) Two-stage abdominal-wall reconstruction of sepsis-induced dehiscence. Plast Reconstr Surg 96(4):898–904

    Article  CAS  Google Scholar 

  24. Martinez JL, Luque-de-León E, Ferat-Osorio E, Estrada-Castellanos A (2017) Predictive value of preoperative serum C-reactive protein for recurrence after definitive surgical repair of enterocutaneous fistula. Am J Surg 213(1):105–111

    Article  Google Scholar 

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Authors and Affiliations

  1. Servicio de Gastrocirugía, UMAE, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Avenida Cuauhtémoc 330, 3er piso, Colonia Doctores, CP 06720, México City, México

    Jose L. Martinez, Luis Manuel Souza-Gallardo & Eduardo Ferat-Osorio

  2. Dirección de Educación e Investigación en Salud, UMAE, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México City, México

    Jose L. Martinez & Eduardo Ferat-Osorio

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  1. Jose L. Martinez
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  2. Luis Manuel Souza-Gallardo
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  3. Eduardo Ferat-Osorio
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Correspondence to Eduardo Ferat-Osorio.

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Martinez, J.L., Souza-Gallardo, L.M. & Ferat-Osorio, E. The Importance of Abdominal Wall Closure After Definitive Surgery for Enterocutaneous Fistula. World J Surg 44, 3333–3340 (2020). https://doi.org/10.1007/s00268-020-05635-7

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  • DOI: https://doi.org/10.1007/s00268-020-05635-7

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