The Management of Enterocutaneous Fistula in a Regional Unit in the United Kingdom: A Prospective Study
| Autor: | Shirley Y. Y. Chan, Alastair Forbes, Alec Engledow, Alastair Windsor, C. Richard G. Cohen, Vivek Datta |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Enterocutaneous fistula medicine.medical_specialty Time Factors Adolescent Fistula Unit (housing) Young Adult Multidisciplinary approach Intestinal failure Intestinal Fistula Humans Medicine Prospective Studies Prospective cohort study Aged Aged 80 and over Nutritional Support business.industry Incidence General surgery Incidence (epidemiology) Gastroenterology Follow up studies General Medicine Middle Aged Plastic Surgery Procedures medicine.disease United Kingdom Surgery Treatment Outcome business Follow-Up Studies |
| Zdroj: | Diseases of the Colon & Rectum. 53:192-199 |
| ISSN: | 0012-3706 |
| Popis: | Enterocutaneous fistula associated with type 2 intestinal failure is a challenging condition that involves a multidisciplinary approach to management. It is suggested that complex cases should only be managed in select national centers in the United Kingdom.Over an 18-month period, we prospectively studied all patients referred to us with established enterocutaneous fistulas. Patients followed standardized protocols. Eradication of sepsis, appropriate wound management, establishment of nutritional support, and restoration of normal physiology were attempted. Definitive surgical management was deferred for at least 6 months after the last abdominal surgical intervention. Follow-up was for a minimum of 6 months.Of 55 patients, 10 were internal referrals and 45 were from institutions elsewhere. The mean age was 50 years. Nine patients had colonic fistulas. Forty-six had small bowel fistulas; 19 of these (35%) were associated with inflammatory bowel disease. Patients had undergone a median of 3 previous operations. Four fistulas (7%) healed spontaneously. Thirty-five patients (63%) underwent definitive surgery. Recurrent fistula occurred in 4 patients (13%); 1 required further surgery, and 3 healed spontaneously. The overall mortality rate was 7% (4/55 patients), with 3 patients dying before definitive surgery and 1 patient dying postoperatively.Our results compare favorably with data from designated national centers (overall mortality, 9.5%-10.8%; operative mortality, 3%-3.5%), suggesting that these patients can be effectively managed in regional units that have sufficient expertise, interest, and volume of patients. Rationalization of funding and referral of patients with type 2 intestinal failure to regional centers may allow national centers to conserve their scarce resources. |
| Databáze: | OpenAIRE |
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