Enterocutaneous Fistula: Different Surgical Intervention Techniques for Closure along with Comparative Evaluation of Aluminum Paint, Karaya Gum (Hollister) and Gum Acacia for Peristomal Skin Care
Introduction: Gastrointestinal fistulas are serious complications and are associated with high morbidity and mortality rates. In majority of the patients, fistulas are treatable. However, the treatment is very complex and often multiple therapies are required. These highly beneficial treatment o...
Main Authors: | , , |
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Format: | Article |
Language: | English |
Published: |
JCDR Research and Publications Private Limited
2015-12-01
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Series: | Journal of Clinical and Diagnostic Research |
Subjects: | |
Online Access: | https://jcdr.net/articles/PDF/6981/16303_CE[Ra]_F(Sh)_PF1(BMAK)_PFA(AK)_PFA2(JOSH%20AK)_PF2(PAG).pdf |
Summary: | Introduction: Gastrointestinal fistulas are serious complications
and are associated with high morbidity and mortality rates. In
majority of the patients, fistulas are treatable. However, the
treatment is very complex and often multiple therapies are
required. These highly beneficial treatment options which could
shorten fistula closure time also result in considerable hospital
cost savings.
Aim: This study was planned to study aetiology, clinical
presentation, morbidity and mortality of enterocutaneous fistula
and to evaluate the different surgical intervention techniques
for closure of enterocutaneous fistula along with a comparative
evaluation of different techniques for management of peristomal
skin with special emphasis on aluminum paint, Karaya gum
(Hollister) and Gum Acacia.
Materials and Methods: This prospective observational study
was conducted in the Department of Surgery, M.L.N. Medical
College, Allahabad and its associated hospital (S.R.N. Hospital,
Allahabad) for a period of five years.
Results: Majority of enterocutaneous fistula were of small
bowel and medium output fistulas (500-1000 ml/24hours).
Most of the patients were treated with conservative treatment
as compared to surgical intervention. Large bowel fistula has
maximum spontaneous closure rate compare to small bowel and
duodenum. Number of orifice whether single or multiple does
not appear to play statistically significant role in spontaneous
closure of fistula. Serum Albumin is a significantly important
predictor of spontaneous fistula closure and mortality. Surgical
management appeared to be the treatment of choice in distal
bowel fistula. The application of karaya gum (Hollister kit), Gum
Acacia and Aluminum Paint gave similar outcome.
Conclusion: Postoperative fistulas are the most common
aetiology of enterocutaneous fistula and various factors do play
role in management. Peristomal skin care done with Karaya
Gum, Gum Acacia and Aluminum Paint has almost equal
efficiency in management of skin excoriation. However, role of
Gum Acacia was found to be good with inflamed, excoriated
and ulcerative skin in comparison to Aluminum Paint and as
efficacious as Karaya Gum but at much lower cost. |
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ISSN: | 2249-782X 0973-709X |