Staged approach in the treatment of patients with enterocutaneous fistulae

To determine an optimal approach in the treatment of patients with intestinal fistulae. We have used the above-mentioned algorithm in the treatment of 46 patients. The majority of patients ( =44, 96%) were transferred under supervision of our multidisciplinary team with severe water-electrolyte dist...

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Bibliographic Details
Published in:	Hirurgija (Moskva) no. 11; p. 66
Main Authors:	Demko, A E, Batyrshin, I M, Shlyapnikov, S A, Ostroumova, Yu S, Sklizkov, D S, Fomin, D V, Pichugina, G A
Format:	Journal Article
Language:	Russian
Published:	Russia (Federation) 2020
Subjects:	Combined Modality Therapy Conservative Treatment Humans Intestinal Fistula - complications Intestinal Fistula - surgery Intestinal Fistula - therapy Nutritional Support - methods Patient Care Team Protein-Energy Malnutrition - etiology Protein-Energy Malnutrition - therapy Treatment Outcome Water-Electrolyte Imbalance - etiology Water-Electrolyte Imbalance - therapy enterocutaneous fistula peritonitis sepsis
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Summary:	To determine an optimal approach in the treatment of patients with intestinal fistulae. We have used the above-mentioned algorithm in the treatment of 46 patients. The majority of patients ( =44, 96%) were transferred under supervision of our multidisciplinary team with severe water-electrolyte disturbances and signs of secondary protein-energy malnutrition (PEM) that required complex combined nutritional support. A two-stage approach was applied in all cases. The first one was conservative and included correction and prevention of infectious complications, nutritional and metabolic therapy, local wound treatment, and anatomical assessment of the fistula. The second stage was reconstructive and implied various reconstructive interventions not earlier than 3 months after formation of the fistula. Conservative approach was followed by fistula healing in 6 patients, surgery was required in 25 patients. Complications with subsequent redo surgery occurred in 4 cases. In all cases, favorable outcome was noted. All 25 patients were discharged. Three patients refused reconstructive surgery after development of fistula, they were also discharged. Mortality rate was 26% ( =12). A multidisciplinary two-stage approach can significantly improve treatment outcomes in patients with intestinal fistulae.
ISSN:	0023-1207
DOI:	10.17116/hirurgia202011166