Management of external small bowel fistulae: Challenges and controversies confronting the general surgeon

Autores
Wainstein, Daniel E.; Tüngler, Victoria; Ravazzola, Constanza; Chara, Osvaldo
Año de publicación
2011
Idioma
inglés
Tipo de recurso
reseña artículo
Estado
versión publicada
Descripción
Background: External small bowel fistulae (ESBF) are serious complications that represent a major challenge for general surgeons. They are still associated with significant morbidity and mortality. This article reviews the management of ESBF with emphasis on the treatment using sub-atmospheric pressure as well a timing, strategies and techniques of reconstructive surgery. Methods: Relevant articles from 1960 to 2010 were identified using various electronic databases to review randomized controlled trials, prospective observational studies, retrospective studies and case reports and highlight key references. Conclusions: External small bowel fistulae require multidisciplinary management and multimodal approaches with a primary essential focus on early recognition and diminishment of mortality factors such as sepsis and malnutrition. In most cases, the initial treatment is conservative, including clinical and nutritional recovery, output control and extensive local wound care. At this stage, the application of local negative pressure is highly effective. This procedure also allows for a spontaneous closure in many patients. Other cases require careful consideration of surgical reconstruction, knowing that success rates are variable and largely dependent on the patient's condition as well as on local aspects of the lesion. Best surgical results are obtained via intra-peritoneal access with extensive enterolysis, resection of the bowel segment from which the fistulae originate and direct abdominal wall closure.
Facultad de Ciencias Exactas
Materia
Ciencias Médicas
Enterocutaneous fistula
Small bowel
Sub-atmospheric pressure
Nivel de accesibilidad
acceso abierto
Condiciones de uso
http://creativecommons.org/licenses/by-nc-sa/4.0/
Repositorio
SEDICI (UNLP)
Institución
Universidad Nacional de La Plata
OAI Identificador
oai:sedici.unlp.edu.ar:10915/84245

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oai_identifier_str oai:sedici.unlp.edu.ar:10915/84245
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network_name_str SEDICI (UNLP)
spelling Management of external small bowel fistulae: Challenges and controversies confronting the general surgeonWainstein, Daniel E.Tüngler, VictoriaRavazzola, ConstanzaChara, OsvaldoCiencias MédicasEnterocutaneous fistulaSmall bowelSub-atmospheric pressureBackground: External small bowel fistulae (ESBF) are serious complications that represent a major challenge for general surgeons. They are still associated with significant morbidity and mortality. This article reviews the management of ESBF with emphasis on the treatment using sub-atmospheric pressure as well a timing, strategies and techniques of reconstructive surgery. Methods: Relevant articles from 1960 to 2010 were identified using various electronic databases to review randomized controlled trials, prospective observational studies, retrospective studies and case reports and highlight key references. Conclusions: External small bowel fistulae require multidisciplinary management and multimodal approaches with a primary essential focus on early recognition and diminishment of mortality factors such as sepsis and malnutrition. In most cases, the initial treatment is conservative, including clinical and nutritional recovery, output control and extensive local wound care. At this stage, the application of local negative pressure is highly effective. This procedure also allows for a spontaneous closure in many patients. Other cases require careful consideration of surgical reconstruction, knowing that success rates are variable and largely dependent on the patient's condition as well as on local aspects of the lesion. Best surgical results are obtained via intra-peritoneal access with extensive enterolysis, resection of the bowel segment from which the fistulae originate and direct abdominal wall closure.Facultad de Ciencias Exactas2011info:eu-repo/semantics/reviewinfo:eu-repo/semantics/publishedVersionRevisionhttp://purl.org/coar/resource_type/c_dcae04bcinfo:ar-repo/semantics/resenaArticuloapplication/pdf198-203http://sedici.unlp.edu.ar/handle/10915/84245enginfo:eu-repo/semantics/altIdentifier/issn/1743-9191info:eu-repo/semantics/altIdentifier/doi/10.1016/j.ijsu.2010.11.009info:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by-nc-sa/4.0/Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)reponame:SEDICI (UNLP)instname:Universidad Nacional de La Platainstacron:UNLP2025-09-29T11:16:10Zoai:sedici.unlp.edu.ar:10915/84245Institucionalhttp://sedici.unlp.edu.ar/Universidad públicaNo correspondehttp://sedici.unlp.edu.ar/oai/snrdalira@sedici.unlp.edu.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:13292025-09-29 11:16:10.393SEDICI (UNLP) - Universidad Nacional de La Platafalse
dc.title.none.fl_str_mv Management of external small bowel fistulae: Challenges and controversies confronting the general surgeon
title Management of external small bowel fistulae: Challenges and controversies confronting the general surgeon
spellingShingle Management of external small bowel fistulae: Challenges and controversies confronting the general surgeon
Wainstein, Daniel E.
Ciencias Médicas
Enterocutaneous fistula
Small bowel
Sub-atmospheric pressure
title_short Management of external small bowel fistulae: Challenges and controversies confronting the general surgeon
title_full Management of external small bowel fistulae: Challenges and controversies confronting the general surgeon
title_fullStr Management of external small bowel fistulae: Challenges and controversies confronting the general surgeon
title_full_unstemmed Management of external small bowel fistulae: Challenges and controversies confronting the general surgeon
title_sort Management of external small bowel fistulae: Challenges and controversies confronting the general surgeon
dc.creator.none.fl_str_mv Wainstein, Daniel E.
Tüngler, Victoria
Ravazzola, Constanza
Chara, Osvaldo
author Wainstein, Daniel E.
author_facet Wainstein, Daniel E.
Tüngler, Victoria
Ravazzola, Constanza
Chara, Osvaldo
author_role author
author2 Tüngler, Victoria
Ravazzola, Constanza
Chara, Osvaldo
author2_role author
author
author
dc.subject.none.fl_str_mv Ciencias Médicas
Enterocutaneous fistula
Small bowel
Sub-atmospheric pressure
topic Ciencias Médicas
Enterocutaneous fistula
Small bowel
Sub-atmospheric pressure
dc.description.none.fl_txt_mv Background: External small bowel fistulae (ESBF) are serious complications that represent a major challenge for general surgeons. They are still associated with significant morbidity and mortality. This article reviews the management of ESBF with emphasis on the treatment using sub-atmospheric pressure as well a timing, strategies and techniques of reconstructive surgery. Methods: Relevant articles from 1960 to 2010 were identified using various electronic databases to review randomized controlled trials, prospective observational studies, retrospective studies and case reports and highlight key references. Conclusions: External small bowel fistulae require multidisciplinary management and multimodal approaches with a primary essential focus on early recognition and diminishment of mortality factors such as sepsis and malnutrition. In most cases, the initial treatment is conservative, including clinical and nutritional recovery, output control and extensive local wound care. At this stage, the application of local negative pressure is highly effective. This procedure also allows for a spontaneous closure in many patients. Other cases require careful consideration of surgical reconstruction, knowing that success rates are variable and largely dependent on the patient's condition as well as on local aspects of the lesion. Best surgical results are obtained via intra-peritoneal access with extensive enterolysis, resection of the bowel segment from which the fistulae originate and direct abdominal wall closure.
Facultad de Ciencias Exactas
description Background: External small bowel fistulae (ESBF) are serious complications that represent a major challenge for general surgeons. They are still associated with significant morbidity and mortality. This article reviews the management of ESBF with emphasis on the treatment using sub-atmospheric pressure as well a timing, strategies and techniques of reconstructive surgery. Methods: Relevant articles from 1960 to 2010 were identified using various electronic databases to review randomized controlled trials, prospective observational studies, retrospective studies and case reports and highlight key references. Conclusions: External small bowel fistulae require multidisciplinary management and multimodal approaches with a primary essential focus on early recognition and diminishment of mortality factors such as sepsis and malnutrition. In most cases, the initial treatment is conservative, including clinical and nutritional recovery, output control and extensive local wound care. At this stage, the application of local negative pressure is highly effective. This procedure also allows for a spontaneous closure in many patients. Other cases require careful consideration of surgical reconstruction, knowing that success rates are variable and largely dependent on the patient's condition as well as on local aspects of the lesion. Best surgical results are obtained via intra-peritoneal access with extensive enterolysis, resection of the bowel segment from which the fistulae originate and direct abdominal wall closure.
publishDate 2011
dc.date.none.fl_str_mv 2011
dc.type.none.fl_str_mv info:eu-repo/semantics/review
info:eu-repo/semantics/publishedVersion
Revision
http://purl.org/coar/resource_type/c_dcae04bc
info:ar-repo/semantics/resenaArticulo
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status_str publishedVersion
dc.identifier.none.fl_str_mv http://sedici.unlp.edu.ar/handle/10915/84245
url http://sedici.unlp.edu.ar/handle/10915/84245
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/issn/1743-9191
info:eu-repo/semantics/altIdentifier/doi/10.1016/j.ijsu.2010.11.009
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
http://creativecommons.org/licenses/by-nc-sa/4.0/
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)
eu_rights_str_mv openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by-nc-sa/4.0/
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)
dc.format.none.fl_str_mv application/pdf
198-203
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instname:Universidad Nacional de La Plata
instacron:UNLP
reponame_str SEDICI (UNLP)
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repository.name.fl_str_mv SEDICI (UNLP) - Universidad Nacional de La Plata
repository.mail.fl_str_mv alira@sedici.unlp.edu.ar
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