Timing of Curative Surgery in Postoperative Enterocutaneous Fistulas

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OBJECTIVE: Evaluate the feasibility of early radical enterocutaneous fistula (ECF) surgery. BACKGROUND: After failure of medical treatment for ECF, the optimal timing of surgical reintervention remains debated. METHODS: Patients undergoing radical ECF surgery to treat postoperative small bowel- ECFs and/or colon-ECFs (2005-2024) were retrospectively included. Success was defined as no remnant ECF or ECF-related stoma at the most recent follow-up and absence of 90-day postoperative mortality. Early ECF surgery was defined as planned surgery (urgent procedures excluded) occurring within 4 months of the last abdominal procedure. RESULTS: Among 200 patients (median 62 years; 43% female; 40% American Society of Anesthesiologists ≥ 3), 77% had small bowel-ECF only, 12% colon-ECF only and 11%. both. Eighty-two percent were referred, with a median delay of 48 days [interquartile range (IQR): 8-200] after ECF diagnosis. Referral center management lasted 34 days (IQR: 3-90), with 10% exceeding 120 days. After excluding 22 emergency procedures, early ECF surgery was performed in 39% (70/178). Early-surgery patients had fewer respiratory comorbidities (9% vs 21%; P = 0.036) and shorter ECF diagnosis-to-transfer interval (16 days vs 145; P = 0.001). Early surgery did not impact operative time ( P = 0.312), mortality ( P = 0.091), severe morbidity ( P = 0.867), and reoperations ( P = 0.511). After a median follow-up of 12 months, the success rate was 74% (permanent stomas = 11%; recurrence = 17%). American Society of Anesthesiologists ≥ 3 ( P = 0.012) and malignancies ( P = 0.010) were independently associated with failure on multivariate analysis, whereas ECF-origin ( P = 0.924) and surgical timing ( P = 0.438) were not. CONCLUSIONS: For postoperative small bowel/colon ECF, the success rate of radical surgery is 74%. Early surgery seems feasible (39%) and does not compromise success. Further prospective studies are needed.

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