Abdominal Wall Surgery in the Setting of an Enterocutaneous Fistula: Combined Versus Staged Definitive Repair
The management of abdominal wall hernias in the presence of an enterocutaneous fistula is a difficult problem requiring mature surgical judgment. The surgeon’s primary goal is to fix the fistula, while definitive repair of the hernia should be relegated to a distant second goal and only if safe. Just because the hernia can be repaired simultaneously does not necessarily mean it should be repaired. Use of a components separation technique for abdominal wall reconstruction at the time of takedown of an enterocutaneous fistula should only be employed in good risk patients without predisposing factors for the formation of an incisional hernia. Advice/help from a reconstructive plastic surgeon to provide vascularized soft-tissue coverage of the fistula repair can be very helpful. Management of these complicated patients requires both expertise in gastrointestinal/metabolic surgery and abdominal wall reconstruction.
KeywordsIncisional hernia Abdominal wall reconstruction Enterocutaneous fistula Bioprosthesis Components separation