View source for Closure of enteric fistula

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = 20G IV+
| monitors = Standard, 5-lead EKG
| considerations_preoperative = Possible SBO, Full stomach considerations
| considerations_intraoperative = 
| considerations_postoperative = NG decompression until bowel function returns
}}

Enteric Fistulae can occur between the bowel and adjacent tissue including but not limited to: abdominal wall, loops of intestine (enteroenteric, enterocolic), enterovesical, enterovaginal. Surgical repair involves excision of the fistula and separating the organs. 


With optimal nonoperative management a fistula may heal spontaneously, the majority within the first 4 weeks after development. Definitive surgical treatment is best achieved with resection of the bowel containing the fistula and anastomosis of healthy normal bowel. The timing of definitive surgery appears to be optimal months after development, if tolerated. Death rates are low after surgery and patients who experience the recurrence of a fistula after initial attempt at closure can ultimately still be cured. <ref>{{Cite journal|last=Ross|first=Howard|date=2010-09|title=Operative Surgery for Enterocutaneous Fistula|url=http://www.thieme-connect.de/DOI/DOI?10.1055/s-0030-1262987|journal=Clinics in Colon and Rectal Surgery|language=en|volume=23|issue=03|pages=190–194|doi=10.1055/s-0030-1262987|issn=1531-0043|pmc=PMC2967319|pmid=21886469}}</ref>

== Overview ==

=== Indications ===

=== Surgical procedure ===

== Preoperative management ==

=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|General Endotracheal Anesthesia
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|Malnutrition, dehydration
Consider full stomach. 

NG decompression until return of bowel function post op
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|Etiology: can be due to carcinoma
|-
|Other
|
|}

=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===

=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
Standard setup with 1 good IV

=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===

=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

== Intraoperative management ==

=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
Standard monitoring

1 good IV

=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
Possible SBO and full stomach precautions with Rapid Sequence Intubation to prevent pulmonary aspiration. 

Patient may be hypovolemic from lack of nutritional support, consider volume load prior to or after induction. 

=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
Supine

Lithotomy access to the anus is helpful 

=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===

=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

== Postoperative management ==

=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
Inpatient

=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
IV vs Epidural analgesia 

=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
Sepsis

Ileus

PONV

== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|50-200cc
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]