Factors affecting closure of fistula and mortality in patient with enterocutaneous fistula

Enterocutaneous fistula is still a serious problem, in spite of development in treatment modalities. Surgeon should evaluate the complications which may occur during treatment and should decide emergency surgery if necessary, or avoid surgery in fistulas that may close spontaneously. Thus definition of the factors that affecting mortality and closing of the fistulas is important.In this study 41 patients with enterocutaneous fistula treated between January 01 2005, and December 31 2008 were reviewed retrospectively. The objective was to evaluate the factors that affecting closure of the fistulas and mortality. The data were obtained from computer records and patient files. SPSS 13 was used for statistical analyses.Of the fistulas 82.9% developed postoperatively and 17.1% were spontaneously. The mean duration of conservative treatment was 19 (7-51) days. Factors that affecting spontaneous closure of the fistula were low output (p<0.001), long fistula tract (p=0.005), colonic fistula (p=0.001), and somatostatine treatment (p=0.006). Rate of the fistula closure in conservative treatment 39% and mortality 12.5%.Of the patients 61% needed a surgical treatment. The indications for surgical treatment were complications such as sepsis, peritonitis and ileus (76%), and failure of conservative treatment (24%). The only factor affecting closure of fistula in patients that treated surgically was sepsis (p=0.010). Fistula closed in 84% of the patients that treated surgically, and the mortality rate was 28%. In general advanced age (p=0.021), sepsis (p<0.001), and hypoalbuminemia (p=0.001), were factors that effecting mortality.Surgical treatment should be avoid as much as possible, and patients treated conservatively. For optimal conservative treatment, factors affecting closure of fistula, and mortality must be kept in mind, complications must be diagnosed, and managed effectively.