Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown

BackgroundThe surgical management of enterocutaneous fistulas (ECFs) in the setting of large abdominal wall defects can be challenging. We aimed to review our experience with simultaneous single-stage ECF takedown and complex abdominal wall reconstruction (AWR).MethodsUsing a prospectively collected database, patients requiring surgical management of an ECF and AWR over a 5-year period were reviewed.ResultsThirty-seven patients (mean age = 58.6 years) underwent ECF repair/AWR. The mean hernia defect size was 426 ± 192 cm2. Thirty-five (95%) patients required fascial releases to achieve abdominal wall closure. Thirty-six (97%) patients had sublay biologic mesh placed to reinforce the repair. Twenty-four (65%) patients developed a surgical site infection (8 superficial, 8 deep, and 8 organ space). Four patients developed an early anastomotic leak/refistulization. With a mean follow-up of 20 months, the hernia recurrence rate was 32% (n = 12).ConclusionsThe simultaneous reconstruction of ECF and complex abdominal wall defects resulted in successful single-stage management of these challenging cases in nearly 70% of patients in this series.