Misky A, Hotouras A, Ribas Y, Ramar S, Bhan C, et al.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain.... Date of publication 2016 Sep 1;volume 18(9):846-51.
1. Colorectal Dis. 2016 Sep;18(9):846-51. doi: 10.1111/codi.13351.
A systematic literature review on the use of vacuum assisted closure for
enterocutaneous fistula.
Misky A(1), Hotouras A(2), Ribas Y(3), Ramar S(4), Bhan C(5).
Author information:
(1)University College London Medical School, London, UK.
(2)North-East London Deanery, University College London Hospital, London, UK.
(3)Department of Surgery, Consorci Sanitari de Terrassa, Terrassa, Barcelona,
Spain.
(4)King's College Hospital, London, UK.
(5)Department of Colorectal Surgery, Whittington Health NHS Trust, University
College London, London, UK.
AIM: Enterocutaneous fistula (ECF) is considered to be one of the most
challenging complications a general surgeon can encounter. The current mainstay
of treatment is surgical closure, associated with significant morbidity and
mortality. Vacuum assisted closure (VAC) has been successfully used for closure
of persistent abdominal wounds for a number of years. This study aims to
investigate whether current literature supports the use of VAC for ECF.
METHOD: A PubMed search of the search terms 'enterocutaneous fistula' and 'vacuum
assisted closure/therapy' was performed in December 2014. Results were restricted
to articles involving human subjects with an available abstract and full text
written between 1950 and 2014. The end-points analysed included rate of fistula
closure, duration of follow-up, and morbidity and mortality where available.
RESULTS: Ten studies (all level IV) including 151 patients were examined. In all
except one, surgery was the underlying aetiology with median number of fistulae
per patient of one. The median rate of closure with VAC was 64.6% (7.7-100%) with
healing occurring within 58 (12-90) days. Follow-up was only mentioned in three
of the 10 studies, in which the patients were followed for 3, 20 and 28.5 months.
No complications were reported in all but one of the studies, in which abdominal
wall disruption and intestinal obstruction were identified in a minority of
patients.
CONCLUSION: The included studies suggest that VAC therapy may be considered a
safe treatment for ECF. The current evidence is generally of low level and
characterized by heterogeneity. Definitive recommendations based on this
information cannot therefore be made. Further studies are necessary to establish
any proven benefit over standard surgical or conservative therapy.
Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and
Ireland.
DOI: 10.1111/codi.13351
PMID: 27088556 [Indexed for MEDLINE]
