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Defining an Enterocutaneous Fistula

Defining an Enterocutaneous Fistula I read with great interest the article by Brenner et al1 in the June 2009 issue of Archives. Recognizing the difficulties inherent to a retrospective analysis of a heterogeneous population of patients, I wished to comment about their intriguing findings. First, I would highlight a correction to Table 2: the recurrence rate between 7 and 12 weeks is only 13%, not 27%. Also, the rate of fistula recurrence for operations earlier than 36 weeks is 9.6%, rather than 12%. Second, a clearer definition of an enterocutaneous fistula would be helpful. It is unusual that the authors report the need for emergency surgery in 10% of patients (7 with anastomotic leak and peritonitis and 7 with abscesses draining to the abdominal wall). Eleven of these 14 emergency procedures were performed within the early period before 36 weeks, representing 32% of that total. Perhaps their inclusion contributes to the better outcomes observed with earlier intervention. Some readers might suggest that an early anastomotic leak and peritonitis represent a technical failure from intestinal resection, rather than a true enterocutaneous fistula. Were radiology procedures to percutaneously control intra-abdominal sepsis less available in the earlier years of the study and a reason emergency surgery was required for patients with abscesses draining to the abdominal wall? Many would choose not to perform definitive surgery for an enterocutaneous fistula in the setting of uncontrolled infection. Finally, did the authors analyze their records to characterize whether a volume-outcome relationship of surgeon experience might explain the differences observed? Back to top Article Information Correspondence: Dr Maa, University of California–San Francisco, Department of Surgery, 521 Parnassus Ave, Room C 341, San Francisco, CA 94143-0790 (john.maa@ucsfmedctr.org). Financial Disclosure: None reported. References 1. M BrennerJL ClaytonA TillouJR HiattHG Cryer Risk factors for recurrence after repair of enterocutaneous fistula. Arch Surg 2009;144 (6) 500- 505PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Defining an Enterocutaneous Fistula

John, Maa
Archives of Surgery , Volume 145 (1) – Jan 1, 2010
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Defining an Enterocutaneous Fistula

Abstract

I read with great interest the article by Brenner et al1 in the June 2009 issue of Archives. Recognizing the difficulties inherent to a retrospective analysis of a heterogeneous population of patients, I wished to comment about their intriguing findings. First, I would highlight a correction to Table 2: the recurrence rate between 7 and 12 weeks is only 13%, not 27%. Also, the rate of fistula recurrence for operations earlier than 36 weeks is 9.6%, rather than 12%. Second, a clearer...
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References (1)

Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.2009.231
Publisher site
See Article on Publisher Site

Abstract

I read with great interest the article by Brenner et al1 in the June 2009 issue of Archives. Recognizing the difficulties inherent to a retrospective analysis of a heterogeneous population of patients, I wished to comment about their intriguing findings. First, I would highlight a correction to Table 2: the recurrence rate between 7 and 12 weeks is only 13%, not 27%. Also, the rate of fistula recurrence for operations earlier than 36 weeks is 9.6%, rather than 12%. Second, a clearer definition of an enterocutaneous fistula would be helpful. It is unusual that the authors report the need for emergency surgery in 10% of patients (7 with anastomotic leak and peritonitis and 7 with abscesses draining to the abdominal wall). Eleven of these 14 emergency procedures were performed within the early period before 36 weeks, representing 32% of that total. Perhaps their inclusion contributes to the better outcomes observed with earlier intervention. Some readers might suggest that an early anastomotic leak and peritonitis represent a technical failure from intestinal resection, rather than a true enterocutaneous fistula. Were radiology procedures to percutaneously control intra-abdominal sepsis less available in the earlier years of the study and a reason emergency surgery was required for patients with abscesses draining to the abdominal wall? Many would choose not to perform definitive surgery for an enterocutaneous fistula in the setting of uncontrolled infection. Finally, did the authors analyze their records to characterize whether a volume-outcome relationship of surgeon experience might explain the differences observed? Back to top Article Information Correspondence: Dr Maa, University of California–San Francisco, Department of Surgery, 521 Parnassus Ave, Room C 341, San Francisco, CA 94143-0790 (john.maa@ucsfmedctr.org). Financial Disclosure: None reported. References 1. M BrennerJL ClaytonA TillouJR HiattHG Cryer Risk factors for recurrence after repair of enterocutaneous fistula. Arch Surg 2009;144 (6) 500- 505PubMedGoogle ScholarCrossref

Journal

Archives of Surgery – American Medical Association

Published: Jan 1, 2010

Keywords: enterocutaneous fistula

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