Treatment Strategies in 135 Consecutive Patients with Enterocutaneous Fistulas

Visschers, Ruben G. J.; Damink, Steven W. M. Olde; Winkens, Bjorn; Soeters, Peter B.; van Gemert, Wim G.

doi:10.1007/s00268-007-9371-1

Cited by 184Abdominal Surgery and ComplicationsDiverticular Disease and ComplicationsInfectious Aortic and Vascular Conditions

Treatment Strategies in 135 Consecutive Patients with Enterocutaneous Fistulas

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Visschers, Ruben G. J., Damink, Steven W. M. Olde, Winkens, Bjorn, Soeters, Peter B., van Gemert, Wim G.·2008·World Journal of Surgery

DOI 10.1007/s00268-007-9371-1PMC PMC2248608

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Abstract

Background: Enterocutaneous fistulas (ECF) pose a major challenge to every gastrointestinal (GI) surgeon. Based on earlier studies, a standardized treatment guideline was implemented. The focus of the present study was to assess that guideline and determine prognostic factors for outcome of patients with ECF, and to define a more detailed therapeutic approach including the convalescence time before restorative surgery. Methods: All patients with ECF treated between 1990 and 2005 were included. Management consisted of controlling Sepsis, Optimization of nutritional state, Wound care, assessment of fistula Anatomy, Timing of surgery, and Surgical strategy (the SOWATS guideline). Prognostic factors were assessed by way of multiple logistic regression analysis. Results: A total of 135 patients were treated at our unit. Overall closure was achieved in 118 patients (87.4%). Restorative operations for fistula closure were performed after a median of 53 days (range: 4–270 days). Restorative operations were successful in 97/107 patients (90.7%). Thirteen patients (9.6%) died. An abdominal wall defect was the most predominant negative prognostic factor for spontaneous closure (odds ratio [OR] = 0.195, confidence interval [CI] 0.052–0.726, p = 0.015). A strong relation was found between preoperative albumin level and surgical closure (p < 0.001) and mortality (p < 0.001). Conclusions: Application of the SOWATS guideline allowed a favorable outcome after a short convalescence period. Abdominal wall defects and preoperative hypoalbuminemia are important prognostic variables.

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When a damage-control approach is successful, nutrition support becomes effective, promoting fat-free mass and adequate healing after eventual reoperation.
“When this approach is successful, nutrition support becomes effective, promoting fat‐free mass (muscle) and adequate healing after eventual reoperation, for instance, to restore”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [100]
The Methods (page not provided) describe controlling sepsis before nutritional optimization and delaying restorative surgery until the patient is clinically and nutritionally fit. The Discussion (page not provided) reports successful later repair, but the paper does not show that nutrition support increased fat-free mass or caused adequate healing after reoperation. (LLM, conf=0.84)
Experimental — accuracy not yet measured
A low serum albumin level is a bad omen for outcome after surgery.
“Despite not always appreciating the precise cause of the connection with inflammation, many surgeons know that a low serum albumin level is a bad omen for outcome after surgery.100, 132, 133, 134, 135, 136, 137, 138”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [100]

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DOI 10.1007/s00268-007-9371-1 Treatment Strategies in 135 Consecutive Patients with
Fistulas, E., Winkens, B., Peter, Æ., Soeters, B., Wim, Æ., Gemert, G., Winkens, B., & van Gemert, W. G. (2008)
Self-citation
Managements Of Enterocutaneous Fistula (ECF)
Alamiri, M. H. (2017) · AL-QADISIYAH MEDICAL JOURNAL · doi:10.28922/qmj.2015.11.20.105-108
Postoperative enterocutaneous fistulas: Management outcomes in 23 consecutive patients
Noori, I. F. (2021) · Annals of Medicine and Surgery · doi:10.1016/j.amsu.2021.102413 · Cited by 16 · see citing works
Guided Treatment Improves Outcome of Patients with Enterocutaneous Fistulas
Visschers, R. G. J., van Gemert, W. G., Winkens, B., Soeters, P. B., & Olde Damink, S. W. M. (2012) · World Journal of Surgery · doi:10.1007/s00268-012-1663-4 · Cited by 72 · see citing works
Self-citation
A Clinical Study on Comprehensive Analysis of Enterocutaneous Fistula
Kunche, S. R., Manoj, A., & Chetan Kumar, A. (2019) · Journal of Evolution of Medical and Dental Sciences · doi:10.14260/jemds/2019/818

Authors: Visschers, R. G. J., Damink, S. W. M. O., Winkens, B., Soeters, P. B., & van Gemert, W. G.
Affiliations: Maastricht University Medical Centre (NL)
Department of Methodology and Statistics Maastricht University PO Box 5800 6202 Maastricht AZ The Netherlands
Department of Surgery, Intestinal Failure Institute Maastricht and Nutrition & Toxicology Research Institute Maastricht (NUTRIM) University Hospital Maastricht Maastricht The Netherlands
ORCID: Visschers, Ruben G. J.
Damink, Steven W. M. Olde
Soeters, Peter B.
Venue: World Journal of Surgery
Publisher: Wiley
Published: 2008-01-04
Volume: 32
Issue: 3
Pages: 445-453
ISSN: 0364-2313 (ISSN-L)
1432-2323
DOI: 10.1007/s00268-007-9371-1
PMC: PMC2248608
OpenAlex: W2041289969
Cited by: 184
References: 35
Citations by year: 2026: 11 · 2025: 14 · 2024: 7 · 2023: 12 · 2022: 9 · 2021: 12 · 2020: 13 · 2019: 4 · 2018: 8 · 2017: 12 · 2016: 16 · 2015: 5 · 2014: 5 · 2013: 11 · 2012: 8
FWCI: 11.03
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/2.0 (vor)
Locations: World Journal of Surgery (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Research Publications (Maastricht University) (publishedVersion, cc-by-nc)
Research Publications (Maastricht University) (submittedVersion, cc-by-nc)
Funders: ZonMw (40‐00703‐97‐06‐177)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
Health Sciences › Medicine › Surgery › Diverticular Disease and Complications
Health Sciences › Medicine › Surgery › Infectious Aortic and Vascular Conditions
Keywords: enterocutaneous fistula, restorative surgery, spontaneous fistula closure, prognostic factors, abdominal wall defect, hypoalbuminemia, preoperative nutritional optimization, sepsis treatment, wound care, timing of surgery, mortality
MeSH terms: Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Intestinal Fistula, Male, Middle Aged, Regression Analysis, Retrospective Studies, Practice Guidelines as Topic, Cutaneous Fistula, Negative-Pressure Wound Therapy

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Treatment Strategies in 135 Consecutive Patients with Enterocutaneous Fistulas

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