Treatment of high-output enterocutaneous fistulas with a vacuum-compaction device. A ten-year experience

World J Surg. 2008 Mar;32(3):430-5. doi: 10.1007/s00268-007-9235-8.

Abstract

Background: Enterocutaneous fistulas arise as complications in 0.8%-2% of abdominal operations. The global mortality rate is 5%-37%, yet it may exceed 60% in the case of high-output fistulas and when sepsis and malnutrition are involved. The objective of this prospective cohort study with retrospective data analyses was to analyze our ten-year experience with a vacuum-compaction device for the management of high-output, postoperative enterocutaneous fistulas at the Department of General Surgery, E. Tornú Hospital, and the Intensive Care Unit, Churruca Hospital, Buenos Aires, Argentina.

Patients and methods: Ninety-one patients presented 179 fistulas; 73 (69.2%) were men whose mean age was 48 years. Sepsis and malnutrition were present in 66 (72.5%). The mean initial fistula output was 1,485 ml/day. Conservative management was carried out according to diagnostic and therapeutic priority staging. A vacuum-compaction system (SIVACO; Spanish acronym) was used to control output.

Results: Output was entirely suppressed in 37 (40.7%) patients after 1-7 days of treatment, and reduced to less than 500 ml/day (average=138) in 52 (57.1%) patients. Spontaneous closure was achieved in 42 (46.2%) patients, whereas 37 (40.7%) patients did not improve after 20-380 (average=111) days of treatment. Those patients required surgical correction, which had an 83.8% success rate. Overall mortality was 16.5% (15 patients).

Conclusions: The vacuum-compaction device proved effective for reducing fistula output in 89 of 91 patients (97.8%).

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Clinical Protocols
  • Cohort Studies
  • Cutaneous Fistula / etiology
  • Cutaneous Fistula / mortality
  • Cutaneous Fistula / surgery*
  • Digestive System Surgical Procedures / adverse effects
  • Female
  • Humans
  • Intestinal Fistula / etiology
  • Intestinal Fistula / mortality
  • Intestinal Fistula / surgery*
  • Male
  • Middle Aged
  • Negative-Pressure Wound Therapy* / instrumentation
  • Negative-Pressure Wound Therapy* / methods
  • Survival Analysis
  • Survival Rate
  • Treatment Outcome