Staged approach in the treatment of patients with enterocutaneous fistulae

OBJECTIVE To determine an optimal approach in the treatment of patients with intestinal fistulae. MATERIAL AND METHODS We have used the above-mentioned algorithm in the treatment of 46 patients. The majority of patients (n=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. RESULTS 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% (n=12). CONCLUSION A multidisciplinary two-stage approach can significantly improve treatment outcomes in patients with intestinal fistulae.