FEASIBILITY OF EARLY SURGICAL INTERVENTION IN POSTOPERATIVE ENTERO-CUTANEOUS FISTULAE
Abstract
Objectives: To study the out come and benefits of an early surgical intervention in postoperativeentero-cutaneous fistulae. Methods: It's a retrospective descriptive study conducted at department of
surgery LUMHS from Jan 2001 to November 2008. Two hundred and thirteen (213) post-operative
fistulae are included as study subjects while those due to inflammatory bowel diseases, road traffic
accidents or following blunt, stab or gunshot abdominal trauma are excluded. An aggressive
treatment to build up nutritional status, correction of anaemia and control of sepsis was followed by
surgical intervention as soon as the patient's condition permitted. Variables such as type of fistula,
out put per 24 hours, duration since development , complications due to fistula, nutritional status,
operative procedure, operative time, post-operative complications, total post-operative stay, follow
up schedule, outcome. The results were statistically analysed on SPSS-12. Results: A total 213
patients comprising 184 males (85.6%) and 29 (13.5%) females with a mean age of 36.08 years and
a range of 64 (78-14) years presenting with post-operative enter-cutaneous fistula are included in the
study. Maximum number of patients (171, 79.5%) developed fistula between 4th-6th postoperative
day and a vast majority of fistula occurred in the ileum (207, 97.18%) either as a result of
anastomotic failure (103), leak from primary closure (99) or from un-noticed missed perforations (5).
Of the total number, 24 patients eventually died making a mortality of 11.2%. Early surgical
intervention proved life saving (p<0.001). A strong relation was found pre-operative albumin levels
and surgical closure of the fistula (p<0.001) and associated mortality (p<0.001). Conclusion: High
out put fistula is unlikely to close spontaneously on conservative measures. Early surgical
intervention can be life saving.
Keywords: Entero-cutaneous fistula, early surgical intervention, morbidity, mortality
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