Outcomes Following Repair of Enterocutaneous Fistulae at a Specialized Center.

BACKGROUND: Enterocutaneous fistula (ECF) is a serious condition that can be challenging to treat with high recurrence and mortality rate. This study reports the characteristics and outcomes of a large series of patients with ECF, aiming at evaluating the rate and factors associated with successful surgical management. METHODS: Data were obtained from a prospectively maintained database at an academic institution. All patients who underwent repair of an enterocutaneous fistula between 2013-2025 were included. Clinical characteristics, operative details, and postoperative outcomes were evaluated. Primary outcomes were fistula recurrence and mortality. Secondary outcomes were intra- and postoperative complications. Regression analysis was used to identify independent risk factors for the primary outcomes. RESULTS: A total of 93 patients (52% female) underwent surgery with median age of 58 years (IQR 44.2-66.6) and body mass index (BMI) of 23.4kg/m2 (IQR 20.4-27.8). Proximate cause of fistula formation was spontaneous in 12 patients (13%), while the remainder were postoperative; 16 patients (17%) had underlying Crohn's disease. Twenty-two patients (24%) had a recurrence, hence 76% had a successful repair. Median time to fistula recurrence was 85 days (IQR 53-372). Mortality occurred in 5 patients (5%). The most common postoperative complications were intra-abdominal or pelvic abscess (19%) and transfusion (28%). Patients with fistula recurrence, when compared to patients with no recurrence, had similar age, BMI, etiology (IBD vs non-IBD), ASA class, gender, race, and comorbidities. A significantly longer length of stay was observed in the recurrence group (18.5 vs 8 days, P < 0.01). Postoperative complications were similar except for anastomotic leak, which was higher in the recurrence group (22.7% vs 7.0%, P=0.053). In the multivariable logistic regression analysis, recurrence was independently associated with high-output fistula (OR 6.62, 95% CI 1.38-31.80, P=0.018), preoperative stoma use (OR 4.36, 95% CI 1.17-16.27, P=0.029), wound class overall (P=0.015), primary repair (OR 4.55, 95% CI 1.10-18.85, P=0.037), and intraoperative transfusion (OR 7.72, 95% CI 1.46-40.74, P=0.016). CONCLUSION: Surgery for ECF can be accomplished with good rates of healing in experienced centers. Recurrence appears to be associated with fistula severity, operative complexity, and intraoperative burden, underscoring the importance of careful patient optimization and meticulous operative management.