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

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.

journal_name

World J Surg

journal_title

World journal of surgery

authors

Martinez JL,Souza-Gallardo LM,Ferat-Osorio E

doi

10.1007/s00268-020-05635-7

subject

Has Abstract

pub_date

2020-10-01 00:00:00

pages

3333-3340

issue

10

eissn

0364-2313

issn

1432-2323

pii

10.1007/s00268-020-05635-7

journal_volume

44

pub_type

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