* 8-year experience of enterocutaneous fistulae at a national intestinal failure centre

Abstract

Aims: Currently there are two national intestinal failure centres in England. The treatment of enterocutaneous fistulae (ECF) is complex and challenging. Our study examines healing and mortality in ECF patients. Methods: A review of ECF in 177 patients with mean age of 48.7 years (median 49 years) treated over 8 years (January 2003-June 2010) has been completed. Results have been compared to a previously reported series from this unit of an 11-year experience of 277 patients. Results: 85 (48.0%) had inflammatory bowel disease (69 Crohn's disease, 16 Ulcerative colitis). Fistulae resulted from surgery in 166 of 177 patients (93.7%). One hundred and fifty patients underwent definitive surgery (84.7%). The overall healing rate following surgery in the current series was 94.6% compared with 82% in the previous series. Mean delay from previous surgery to current operation was 1 year compared with 8 months in the previous series. Thirty day post fistulae resection mortality was 0% compared with 3.5% in the previous series. Twenty-seven underwent medical management alone with overall healing rate of 46.4% compared to 19.9% in the previous series. Conclusion: By far the greatest aetiology for ECF formation was surgery performed in patients with inflammatory bowel disease. Surgical management of ECF is safe and improving. Factors contributing to improved outcome include an improved cohesion of our multidisciplinary team, an increase in mean delay time to surgery, insistence that the patient is discharged home prior to surgery wherever possible and improved medical management of Crohn's disease with immunosuppressive and biological drugs.