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. 2017 Jul-Aug;38(4):185-198.
doi: 10.11138/gchir/2017.38.4.185.

Surgery for post-operative entero-cutaneous fistulas: is bowel resection plus primary anastomosis without stoma a safe option to avoid early recurrence? Report on 20 cases by a single center and systematic review of the literature

A Lauro, R Cirocchi, N Cautero, A Dazzi, D Pironi, F M Di Matteo, A Santoro, S Faenza, L Pironi, A D Pinna

Surgery for post-operative entero-cutaneous fistulas: is bowel resection plus primary anastomosis without stoma a safe option to avoid early recurrence? Report on 20 cases by a single center and systematic review of the literature

A Lauro et al. G Chir. 2017 Jul-Aug.

Abstract

Background: A review was performed on entero-cutaneous fistula (ECF) repair and early recurrence, adding our twenty adult patients (65% had multiple fistulas).

Methods: The search yielded 4.098 articles but only 15 were relevant: 1.217 patients underwent surgery. The interval time between fistula's diagnosis and operative repair was between 3 months and 1 year. A bowel resection with primary anastomosis was performed in 1.048 patients, 192 (18.3%) underwent a covering stoma: 856 patients (81.7%) had a fistula takedown in one procedure.

Results: The patients had 14.3% recurrence and 13.1% mortality rate. In our experience 75% were surgically treated after a period equal or above one year from fistula occurrence: surgery was very demolitive (in 40% remnant small bowel was less than 100 cm). We performed a bowel resection with a hand-sewn anastomosis (95%) without temporary stoma. In-hospital mortality was 0% and at discharge all were back to oral intake with 0% early re-fistulisation.

Conclusions: Literature supports our experience: ECF takedown could be safely performed after an adequate period of recovery from 3 months to one year from fistula occurrence. In our series primary repair (bowel resection plus reconnection surgery without temporary stoma) avoided an early recurrence without mortality.

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Conflict of interest statement

Conflict of interest

None.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Surgical access to abdominal cavity, surrounding entero-cutaneous fistula.
Figure 3
Figure 3
Exposure of entero-cutaneous fistula before fistula takedown.
Figure 4
Figure 4
Resection by stapler of entero-cutaneous fistula with involved bowel loops.
See this image and copyright information in PMC

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