Guided Treatment Improves Outcome of Patients with Enterocutaneous Fistulas
Open accessAbstract
Background: The present study was designed to evaluate the effects of guided treatment of patients with an enterocutaneous fistula and to evaluate the effect of prolonged period of convalescence on outcome. Methods: All consecutive patients with an enterocutaneous fistula treated between 2006 and 2010 were included in this study. Patient information was gathered prospectively. Treatment of patients focused on sepsis control, optimization of nutritional status, wound care, establishing the anatomy of the fistula, timing of surgery, and surgical principles. Outcome included spontaneous and surgical closure, mortality, and postoperative recurrence. The relationship between period of convalescence and recurrence rate was determined by combining the present prospective cohort with a historical cohort from our group. Results: Between 2006 and 2010, 79 patients underwent focused treatment for enterocutaneous fistula. Cox regression analysis showed that period of convalescence related significantly with recurrence of the fistula (hazard ratio 0.99; 95 % confidence interval 0.98–0.999; p = 0.04). Spontaneous closure occurred in 23 (29 %) patients after a median period of convalescence of 39 (range 7–163) days. Forty‐nine patients underwent operative repair after median period of 101 (range 7–374) days and achieved closure in 47 (96 %). Overall, eight patients (10 %) died. Conclusions: Prolonging period of convalescence for patients with enterocutaneous fistulas improves spontaneous closure and reduces recurrence rate.
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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 [139]
The Patients and methods section (page not provided) describes sepsis control and adequate nutrition as conditions for restorative surgery, and the Results report successful fistula closure after surgery. The paper does not show that nutrition support becomes effective specifically after damage control, promotes fat-free mass, or causes postoperative healing. (LLM, conf=0.84)
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- Authors
- Visschers, R. G. J., van Gemert, W. G., Winkens, B., Soeters, P. B., & Olde Damink, S. W. M.
- Affiliations
- Maastricht University Medical Centre (NL)
- Department of Surgery, Maastricht University Medical Centre NUTRIM School for Nutrition, Toxicology & Metabolism, Maastricht University PO Box 5800 6202 AZ Maastricht The Netherlands
- Department of Methodology and Statistics and The School for Public Health and Primary Care Maastricht University P Debyeplein 1 6229 HA Maastricht The Netherlands
- Corresponding author
- Visschers, Ruben G. J.
- Venue
- World Journal of Surgery
- Publisher
- Wiley
- Published
- 2012-06-06
- Volume
- 36
- Issue
- 10
- Pages
- 2341-2348
- ISSN
- 0364-2313 (ISSN-L)
- 1432-2323
- PMC
- PMC3465546
- OpenAlex
- W2077400125
- Cited by
- 72
- References
- 30
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 1 · 2023: 10 · 2022: 6 · 2021: 9 · 2020: 11 · 2019: 3 · 2018: 4 · 2017: 8 · 2016: 8 · 2015: 2 · 2014: 1 · 2013: 1
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- World Journal of Surgery (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- ZonMw (907‐06‐177, 920‐03‐537)
- 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, spontaneous fistula closure, fistula recurrence, sepsis control, nutritional optimization, wound care, timing of surgery, operative repair, mortality
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Humans, Intestinal Fistula, Male, Middle Aged, Prospective Studies, Surgical Procedures, Operative, Treatment Outcome, Young Adult
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