Role of Early Surgical Diversion Procedure in the Management of Enterocutaneous Fistulae
Keywords:Enterocutaneous fistula, Stoma, Total Parenteral Nutrition (T.P.N.).
This prospective, non-randomized comparative clinical study about the role of early proximal surgical diversion and TPN for treating patients with enterocutaneous fistula was conducted in Department of Surgery Mayo Hospital, Lahore. Main objective was to evaluate the role of early proximal diversion to minimize the hospital stay, decrease the expenses of hospitalization and reduction of morbidity and mortality associated with the enterocutaneous fistula. Total 32 patients, either referred from periphery or presenting to the Emergency Department with peritonitis, intestinal obstruction or abdominal trauma and who developed distal small bowel or colonic fistulas after primary surgery were included in the study. These patients were equally divided into two groups; Group A underwent conservative management with Total Parenteral Nutrition (T.P.N) for 6 weeks and Group B patients were subjected to early stoma formation. In Group A patients spontaneous closure rate of fistula was 56.25% with meantime of 6 weeks. Five patients 31.25%)of this group died due to uncontrollable sepsis. Two patients required definitive surgery after failure of six weeks of conservative management. Among Group B patients only 2 patients (12.5%) died and rest of them were discharged with stoma after mean time stay of 6.0 days. Stoma was closed after three months and mean stay time after stoma closure was 5.0 days. Both groups suffered from complications but the problems encountered by Group A patients were more disastrous. Similarly, these patients had to spend more money as compared to Group B patients.
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