RT Journal
A1 Brenner M, Clayton JL, Tillou A, Hiatt JR, Cryer HG
T1 RIsk factors for recurrence after repair of enterocutaneous fistula
JF Archives of Surgery
JO Archives of Surgery
YR 2009
FD June 1
VO 144
IS 6
SP 500
OP 505
DO 10.1001/archsurg.2009.66
UL http://dx.doi.org/10.1001/archsurg.2009.66
AB Objectives 
    To assess outcomes after repair of enterocutaneous fistulae (ECF) and identify factors that predict mortality and recurrence.Design 
    Retrospective study.Setting 
    University hospital.Patients 
    One hundred thirty-five patients undergoing ECF repair between 1989 and 2005.Main Outcome Measures 
    Mortality and recurrence of ECF.Results 
    Definitive operation for ECF was attempted in 135 patients. Mortality was 8%, recurrence was 17%, and 84% of patients eventually survived with a closed fistula. The primary determinant of mortality was ECF recurrence (odds ratio [OR], 6.7; 95% confidence interval [CI], 1.9-23.4). Factors independently associated with ECF recurrence by multivariate logistic regression included the presence of inflammatory bowel disease (OR, 4.9; 95% CI, 1.5-16.1), interval between diagnosis and operation of 36 weeks or longer (OR, 5.4; 95% CI, 1.8-16.4), location of fistulae in the small intestine (OR, 9.8; 95% CI, 1.7-57.6), and resection with stapled anastomosis (OR, 4.1; 95% CI, 1.3-13.2). Recurrence of ECF was 35% with resection and stapled anastomosis, 22% with simple oversew, and 11% with resection and hand-sewn anastomosis. Recurrence of ECF was 12% when operation was performed prior to 36 weeks from diagnosis, compared with 36% if performed at or beyond 36 weeks.Conclusions 
    The primary determinant of mortality after ECF repair is a failed operation leading to recurrence of the fistula. Risk factors for ECF recurrence include inflammatory bowel disease, fistula located in the small intestine, an interval of 36 weeks or longer between diagnosis and operation, and resection with stapled anastomosis.