Different approaches in the management of enterocutaneous fistula
Keywords:ECF, Conservative approach, Secondary exploration
Background: Enterocutaneous fistula (ECF) are abnormal communications between the skin and gastrointestinal tract. ECF are a difficult and costly surgical complication to manage.
Methods: The aim of this study is to compare the outcomes and review the different approaches in the management of ECF. We conducted a retrospective study on 50 postoperative ECF patients after abdominal surgeries over a period of 10 months admitted through PMCH OPD and emergency. We included 30 men and 20 females between age 10-70 years. We excluded spontaneous fistula in Crohn’s disease, intestinal diverticulosis, or any inflammatory disease.
Results: Out of 50 patients of ECF 42 (8%) were managed conservatively initially. Out of that 9 patients failed to respond to conservative management and required later secondary exploration. Eight patients (16%) needed initial primary surgical intervention after formation of faecal fistula and peritonitis. The overall incidence of ECF is 4% varied according to surgery type, -4% after colorectal surgeries, 7% after gastroduodenal surgeries, 0.5% after extra-digestive surgery. Conservative approach includes resuscitation, nutritional support, sepsis control, output control and skin protection whereas in Surgical management we included permanent closure of fistula, resection of fistula tract, anastomosis and excision of tract and direct drainage.
Conclusions: Conservative treatment plays a pivotal role as an initial management in both low and high fistula output. There was no significant recurrence rate difference seen in conservative and surgical approach.
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