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Megan Brenner, MD, MS; John L. Clayton, MD, PhD; Areti Tillou, MD, MSEd; Jonathan R. Hiatt, MD; H. G. Cryer, MD, PhD

Arch Surg. 2009;144(6):500-505.

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.

Author Affiliations: Division of General Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles.

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