Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery

A. Craig Lynch, Conor P. Delaney, Anthony J. Senagore, Jason T. Connor, Feza H. Remzi, Victor W. Fazio

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

Objective: Recent experience with surgery for enterocutaneous fistulae (ECF) at a specialist colorectal unit is reviewed to define factors relating to a successful surgical outcome. Summary Background Data: ECF cause significant morbidity and mortality and need experienced surgical management. Previous publications have concentrated on mortality resulting from fistulae, while factors affecting recurrence have not previously been a focus of analysis. Methods: Records were reviewed of patients who had ECF surgery (1994-2001). Management strategy involved early drainage of sepsis and nutritional support prior to elective ECF repair, with selective defunctioning proximal stoma formation. Results: A total of 205 patients were available (89 males, 43%; median age, 51 years; range, 16-86) years). ECF were related to Crohn's disease in 95, ulcerative colitis in 18, diverticular disease in 17, carcinoma in 25 (16 after radiotherapy), mesh ventral hernia repair in 21, and other causes in 29. Forty-one (20%) had undergone attempted fistula repair at other institutions. Initial management included CT-guided drainage of an intra-abdominal abscess in 23 patients, and total parenteral nutrition in 74 (36%). A total of 203 patients had definitive ECF repair. Forty-four had oversewing or wedge resection of the fistula, and 159 had resection and reanastomosis of the involved small bowel segment or ileocolic anastomosis. Ninety-day operative mortality was 3.5%. A total of 42 (20.5%) patients developed ECF recurrence within 3 months. Multivariate analysis demonstrated that recurrence was more likely after over-sewing (36%) than resection (16%, P = 0.006). Conclusions: A strategy of drainage of acute sepsis, maintenance of nutritional support prior to surgery, and selective use of PS allows for primary closure in 80% of complicated ECF. Resection should be performed when feasible.

Original languageEnglish (US)
Pages (from-to)825-831
Number of pages7
JournalAnnals of Surgery
Volume240
Issue number5
DOIs
StatePublished - Nov 2004
Externally publishedYes

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Intestinal Fistula
Recurrence
Fistula
Drainage
Nutritional Support
Mortality
Sepsis
Ventral Hernia
Abdominal Abscess
Total Parenteral Nutrition
Herniorrhaphy
Ulcerative Colitis
Crohn Disease
Radiotherapy
Multivariate Analysis
Maintenance
Morbidity
Carcinoma

ASJC Scopus subject areas

  • Surgery

Cite this

Lynch, A. C., Delaney, C. P., Senagore, A. J., Connor, J. T., Remzi, F. H., & Fazio, V. W. (2004). Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery. Annals of Surgery, 240(5), 825-831. https://doi.org/10.1097/01.sla.0000143895.17811.e3

Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery. / Lynch, A. Craig; Delaney, Conor P.; Senagore, Anthony J.; Connor, Jason T.; Remzi, Feza H.; Fazio, Victor W.

In: Annals of Surgery, Vol. 240, No. 5, 11.2004, p. 825-831.

Research output: Contribution to journalArticle

Lynch, AC, Delaney, CP, Senagore, AJ, Connor, JT, Remzi, FH & Fazio, VW 2004, 'Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery', Annals of Surgery, vol. 240, no. 5, pp. 825-831. https://doi.org/10.1097/01.sla.0000143895.17811.e3
Lynch, A. Craig ; Delaney, Conor P. ; Senagore, Anthony J. ; Connor, Jason T. ; Remzi, Feza H. ; Fazio, Victor W. / Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery. In: Annals of Surgery. 2004 ; Vol. 240, No. 5. pp. 825-831.
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abstract = "Objective: Recent experience with surgery for enterocutaneous fistulae (ECF) at a specialist colorectal unit is reviewed to define factors relating to a successful surgical outcome. Summary Background Data: ECF cause significant morbidity and mortality and need experienced surgical management. Previous publications have concentrated on mortality resulting from fistulae, while factors affecting recurrence have not previously been a focus of analysis. Methods: Records were reviewed of patients who had ECF surgery (1994-2001). Management strategy involved early drainage of sepsis and nutritional support prior to elective ECF repair, with selective defunctioning proximal stoma formation. Results: A total of 205 patients were available (89 males, 43{\%}; median age, 51 years; range, 16-86) years). ECF were related to Crohn's disease in 95, ulcerative colitis in 18, diverticular disease in 17, carcinoma in 25 (16 after radiotherapy), mesh ventral hernia repair in 21, and other causes in 29. Forty-one (20{\%}) had undergone attempted fistula repair at other institutions. Initial management included CT-guided drainage of an intra-abdominal abscess in 23 patients, and total parenteral nutrition in 74 (36{\%}). A total of 203 patients had definitive ECF repair. Forty-four had oversewing or wedge resection of the fistula, and 159 had resection and reanastomosis of the involved small bowel segment or ileocolic anastomosis. Ninety-day operative mortality was 3.5{\%}. A total of 42 (20.5{\%}) patients developed ECF recurrence within 3 months. Multivariate analysis demonstrated that recurrence was more likely after over-sewing (36{\%}) than resection (16{\%}, P = 0.006). Conclusions: A strategy of drainage of acute sepsis, maintenance of nutritional support prior to surgery, and selective use of PS allows for primary closure in 80{\%} of complicated ECF. Resection should be performed when feasible.",
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AB - Objective: Recent experience with surgery for enterocutaneous fistulae (ECF) at a specialist colorectal unit is reviewed to define factors relating to a successful surgical outcome. Summary Background Data: ECF cause significant morbidity and mortality and need experienced surgical management. Previous publications have concentrated on mortality resulting from fistulae, while factors affecting recurrence have not previously been a focus of analysis. Methods: Records were reviewed of patients who had ECF surgery (1994-2001). Management strategy involved early drainage of sepsis and nutritional support prior to elective ECF repair, with selective defunctioning proximal stoma formation. Results: A total of 205 patients were available (89 males, 43%; median age, 51 years; range, 16-86) years). ECF were related to Crohn's disease in 95, ulcerative colitis in 18, diverticular disease in 17, carcinoma in 25 (16 after radiotherapy), mesh ventral hernia repair in 21, and other causes in 29. Forty-one (20%) had undergone attempted fistula repair at other institutions. Initial management included CT-guided drainage of an intra-abdominal abscess in 23 patients, and total parenteral nutrition in 74 (36%). A total of 203 patients had definitive ECF repair. Forty-four had oversewing or wedge resection of the fistula, and 159 had resection and reanastomosis of the involved small bowel segment or ileocolic anastomosis. Ninety-day operative mortality was 3.5%. A total of 42 (20.5%) patients developed ECF recurrence within 3 months. Multivariate analysis demonstrated that recurrence was more likely after over-sewing (36%) than resection (16%, P = 0.006). Conclusions: A strategy of drainage of acute sepsis, maintenance of nutritional support prior to surgery, and selective use of PS allows for primary closure in 80% of complicated ECF. Resection should be performed when feasible.

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