RESUMO
Many enterocutaneous fistulas (ECF) require operative treatment. Despite recent advances, rates of recurrence have not changed substantially. This study aims to determine factors associated with recurrence and mortality in patients submitted to surgical repair of ECF. Consecutive patients submitted to surgical repair of ECF during a 5-year period were studied. Several patient, disease, and operative variables were assessed as factors related to recurrence and mortality through univariate and multivariate analysis. There were 35 male and 36 female patients. Median age was 52 years (range, 17-81). ECF recurred in 22 patients (31%), 18 of them (82%) eventually closed with medical and/or surgical treatment. Univariate analyses disclosed noncolonic ECF origin (p = 0.04), high output (p = 0.001), and nonresective surgical options (p = 0.02) as risk factors for recurrence; the latter two remained significant after multivariate analyses. A total of 14 patients died (20%). Univariate analyses revealed risk factors for mortality at diagnosis or referral including malnutrition (p = 0.03), sepsis (p = 0.004), fluid and electrolyte imbalance (p = 0.001), and serum albumin <3 g/dl (p = 0.02). Other significant variables were interval from last abdominal operation to ECF operative treatment ≤20 weeks (p = 0.03), preoperative serum albumin <3 g/dl (p = 0.001), and age ≥55 years (p = 0.03); the latter two remained significant after multivariate analyses. Interestingly, recurrence after surgical treatment was not associated with mortality (p = 0.75). Among several studied variables, recurrence was only independently associated with high output and type of surgical treatment (operations not involving resection of ECF). Interestingly, once ECF recurred its management was as successful as non-recurrent fistulas in our series. Mortality was associated to previously-reported bad prognostic factors at diagnosis or referral.
Assuntos
Fístula Cutânea/mortalidade , Fístula Cutânea/cirurgia , Fístula Intestinal/mortalidade , Fístula Intestinal/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fístula Cutânea/complicações , Feminino , Humanos , Fístula Intestinal/complicações , Masculino , Desnutrição/complicações , Pessoa de Meia-Idade , Análise Multivariada , Período Pré-Operatório , Recidiva , Reoperação , Fatores de Risco , Sepse/complicações , Albumina Sérica , Desequilíbrio Hidroeletrolítico/complicações , Adulto JovemRESUMO
BACKGROUND: Enterocutaneous fistulas arise as complications in 0.8%-2% of abdominal operations. The global mortality rate is 5%-37%, yet it may exceed 60% in the case of high-output fistulas and when sepsis and malnutrition are involved. The objective of this prospective cohort study with retrospective data analyses was to analyze our ten-year experience with a vacuum-compaction device for the management of high-output, postoperative enterocutaneous fistulas at the Department of General Surgery, E. Tornú Hospital, and the Intensive Care Unit, Churruca Hospital, Buenos Aires, Argentina. PATIENTS AND METHODS: Ninety-one patients presented 179 fistulas; 73 (69.2%) were men whose mean age was 48 years. Sepsis and malnutrition were present in 66 (72.5%). The mean initial fistula output was 1,485 ml/day. Conservative management was carried out according to diagnostic and therapeutic priority staging. A vacuum-compaction system (SIVACO; Spanish acronym) was used to control output. RESULTS: Output was entirely suppressed in 37 (40.7%) patients after 1-7 days of treatment, and reduced to less than 500 ml/day (average=138) in 52 (57.1%) patients. Spontaneous closure was achieved in 42 (46.2%) patients, whereas 37 (40.7%) patients did not improve after 20-380 (average=111) days of treatment. Those patients required surgical correction, which had an 83.8% success rate. Overall mortality was 16.5% (15 patients). CONCLUSIONS: The vacuum-compaction device proved effective for reducing fistula output in 89 of 91 patients (97.8%).
Assuntos
Fístula Cutânea/cirurgia , Fístula Intestinal/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Estudos de Coortes , Fístula Cutânea/etiologia , Fístula Cutânea/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Humanos , Fístula Intestinal/etiologia , Fístula Intestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Tratamento de Ferimentos com Pressão Negativa/métodos , Análise de Sobrevida , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: The presence of fistulous communications between the small bowel and the skin continues to be one of the most perplexing and challenging problems facing the surgeon today. Their occurrence is a major catastophe of surgical practice because are frequently a result of technical failure or errors in surgical judgement. MATERIAL, METHOD AND RESULTS: Thirty four patients with high-output enterocutaneous fistulae arising from the small intestine are reported. Fourteen were due to appendicitis and sixteen were infants. Fistula resection were performed in six patients. Spontaneous fistula closure occurred in twenty-eight. Six died. The treatment program included parenteral nutritition thorugh central venous line, local care and antibiotics. CONCLUSIONS: In recent years, more aggressive therapy accompanied by the development of high caloric parenteral alimentation shows promise of reducing the mortality and morbidity rates associated with these fistulas.
Assuntos
Fístula Cutânea , Fístula Intestinal , Intestino Delgado , Adolescente , Criança , Pré-Escolar , Fístula Cutânea/etiologia , Fístula Cutânea/mortalidade , Fístula Cutânea/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Fístula Intestinal/etiologia , Fístula Intestinal/mortalidade , Fístula Intestinal/terapia , Masculino , MéxicoRESUMO
BACKGROUND: Despite of advances obtained today, the enterocutaneous fistula has a mortality rate from 25 to 50%. The presence of cancer increases death frequency and makes difficult its treatment. OBJECTIVE: Evaluate the results of management of enterocutaneous fistula in cancer patients. METHODS: Seventy six cancer patients with average age of 56.8 +/- 13.5 years old and received curative primary treatment for malignancy at the Oncology Hospital, National Medical Center in Mexico who developed an enterocutaneous fistula between 1992 and 2002 were studied. RESULTS: Resolution of fistula was obtained in 52 patients (68.4%). Among these 52, 41 fistulae (53.9%) resolved spontaneously, and 11 required surgical treatment. All patients were treated with parenteral nutrition and octreotide. The meantime to fistula resolution, in those patients whose fistula was spontaneously resolved, was 20 days. Among the 24 patients who died, 21 had sepsis. Fistula-related mortality was highest in those patients with postoperative origin (82%; p = 0.024), of high output (57%; p = 0.001) and ileum site (45%; p = 0.04). CONCLUSIONS: The spontaneous closure is high and the surgical treatment is the best option. The mortality rate is moderate and sepsis the most frequent cause of death.