Enterocutaneous Fistula in the African Settings: Evidence-Based Strategies and Updates (
Authors
Bamidele Johnson Alegbeleye Department of Surgery, St Elizabeth Catholic General Hospital, Shisong, P.O Box 8, Kumbo-Nso, Northwestern Region, Cameroon
Background: Enterocutaneous fistula remains an enigma and constitutes one of the most challenging situations to the patient, the caregiver, and the surgeon. Notwithstanding the conglomerates of recent progress in critical care, therapeutics, as well as nutritional support; there is yet attendant high mortality and morbidity. Interestingly, there is the obscurity of the work of literature on the condition in most African settings. Therefore, this article aimed to provide updated data on this critical postoperative complication of abdominal surgery. Method: Published articles discussing enterocutaneous fistula up to April 2020 were obtained for review from Medline search, medical libraries, and Google. The google search was done in the English language. Interestingly, the search was conducted using the words “enterocutaneous fistula,” “intestinal fistula,” “bowel fistula,” “enteric fistula,” “fistula surgery,” and “fistula and surgical diseases burden”. Ultimately, sixteen materials were included in the quantitative analysis. Some were excluded from the subgroup analyses. Discussion: Treatment of enterocutaneous fistula remains a surgical challenge despite the recent improvement of supportive patient care. Once enterocutaneous fistula occurs, adequate stabilization of the patient, a thorough investigation of the fistula anatomy, and nonoperative management should initially be attempted. The majority of the uncomplicated enterocutaneous fistula will close spontaneously when adequately managed. Interestingly, a simple suture of the fistula is not recommended. However, to intervene surgically as per uncomplicated fistula requires careful planning, meticulous dissection, resection, and anastomosis or bypass procedures are the preferred surgical procedures; besides, reconstruction of the abdominal wall is critical. A multidisciplinary team approach with a gastroenterologist, interventional radiologists, dieticians, enterostomal therapy nurses, and surgeons will maximize successful enterocutaneous fistula closure.
