The Importance of Abdominal Wall Closure After Definitive Surgery for Enterocutaneous Fistula
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ORIGINAL SCIENTIFIC REPORT
The Importance of Abdominal Wall Closure After Definitive Surgery for Enterocutaneous Fistula Jose L. Martinez1,2
•
Luis Manuel Souza-Gallardo1 • Eduardo Ferat-Osorio1,2
Ó Socie´te´ Internationale de Chirurgie 2020
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.
Introduction
& Eduardo Ferat-Osorio [email protected] 1
Servicio de Gastrocirugı´a, UMAE, Hospital de Especialidades del Centro Me´dico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Avenida Cuauhte´moc 330, 3er piso, Colonia Doctores, CP 06720 Me´xico City, Me´xico
2
Direccio´n de Educacio´n e Investigacio´n en Salud, UMAE, Hospital de Especialidades del Centro Me´dico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Me´xico City, Me´xico
The open abdomen (OA) represents a surgical strategy for the management of complicated and difficult abdominal settings such as damage control surgery for trauma, acute mesenteric ischemia, severe intra-abdominal infection, necrotizing infection of the abdominal wall and intra-abdominal hypertension or abdominal compartment syndrome [1]. It permits access to the peritoneal cavity repeatedly to complete debridement, drainage or control the intra-abdominal pressure, to lower mortality [1, 2]. Nonetheless, this therapeutic option is correlated with high morbidity and complication rates. The closure of the abdominal fascial defect must be done as early as clinically
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World J Surg
possible since the risks
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