Surgical treatment of complex enterocutaneous fistulas in IBD patients using human acellular dermal matrix

Timucin Taner, Robert R. Cima, David Larson, Eric Dozois, John H. Pemberton, Bruce G. Wolff

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Inflammatory bowel disease (IBD) patients represent a high-risk group for enterocutaneous fistula (ECF) formation, related to both their disease process and the need for multiple surgeries. Often the abdominal wall is significantly involved with the ECF and requires partial resection. The use of synthetic prosthetic material to reconstruct the abdominal wall after ECF surgery is associated with increased risk of infection and recurrent fistulas. Herein we report the use human acellular dermal matrix (hADM) in the surgical treatment and reconstruction of the abdominal wall in 11 consecutive IBD patients with complex and medically refractory ECF. Methods: After resection of the involved bowel segment and the overlying abdominal wall, a single sheet of hADM was used to reconstruct the defect. Pre- and perioperative risk factors were reviewed and patients were followed prospectively for a year (360 ± 118 days). Results: Operative mortality was nil. Three patients (27%) developed subcutaneous seroma and there were 2 cases (18%) of superficial wound infection, all of which resolved with conservative management. The mean length of hospital stay was 13.5 (±7.2) days and all patients were tolerating an oral diet at the time of dismissal. There were no recurrences. One patient with Crohn's disease developed a new ECF from a separate bowel site on postoperative day 145, which was treated with the same surgical approach. No further complications have occurred. Conclusions: Our results indicate that in a high-risk IBD patient population with multiple perioperative risk factors the use of hADM during ECF takedown is an effective and well-tolerated treatment option.

Original languageEnglish (US)
Pages (from-to)1208-1212
Number of pages5
JournalInflammatory Bowel Diseases
Volume15
Issue number8
DOIs
StatePublished - 2009

Fingerprint

Acellular Dermis
Intestinal Fistula
Inflammatory Bowel Diseases
Abdominal Wall
Therapeutics
Length of Stay
Seroma
Wound Infection
Crohn Disease
Fistula
Diet
Recurrence
Mortality

Keywords

  • Acellular dermal matrix
  • Enterocutaneous fistula
  • Infammatory bowel disease

ASJC Scopus subject areas

  • Gastroenterology
  • Immunology and Allergy

Cite this

Surgical treatment of complex enterocutaneous fistulas in IBD patients using human acellular dermal matrix. / Taner, Timucin; Cima, Robert R.; Larson, David; Dozois, Eric; Pemberton, John H.; Wolff, Bruce G.

In: Inflammatory Bowel Diseases, Vol. 15, No. 8, 2009, p. 1208-1212.

Research output: Contribution to journalArticle

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N2 - Background: Inflammatory bowel disease (IBD) patients represent a high-risk group for enterocutaneous fistula (ECF) formation, related to both their disease process and the need for multiple surgeries. Often the abdominal wall is significantly involved with the ECF and requires partial resection. The use of synthetic prosthetic material to reconstruct the abdominal wall after ECF surgery is associated with increased risk of infection and recurrent fistulas. Herein we report the use human acellular dermal matrix (hADM) in the surgical treatment and reconstruction of the abdominal wall in 11 consecutive IBD patients with complex and medically refractory ECF. Methods: After resection of the involved bowel segment and the overlying abdominal wall, a single sheet of hADM was used to reconstruct the defect. Pre- and perioperative risk factors were reviewed and patients were followed prospectively for a year (360 ± 118 days). Results: Operative mortality was nil. Three patients (27%) developed subcutaneous seroma and there were 2 cases (18%) of superficial wound infection, all of which resolved with conservative management. The mean length of hospital stay was 13.5 (±7.2) days and all patients were tolerating an oral diet at the time of dismissal. There were no recurrences. One patient with Crohn's disease developed a new ECF from a separate bowel site on postoperative day 145, which was treated with the same surgical approach. No further complications have occurred. Conclusions: Our results indicate that in a high-risk IBD patient population with multiple perioperative risk factors the use of hADM during ECF takedown is an effective and well-tolerated treatment option.

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