ABSTRACT
Postoperative enteroatmospheric fistula (EAF) presents a complex challenge in surgical care, with multifactorial causes and significant implications for patient outcomes and quality of life. This narrative review explores the essential role of nurses in the comprehensive management of EAF, encompassing preoperative, intraoperative, and postoperative care. It emphasizes the importance of wound care management, nutritional support, psychosocial assistance, patient education, collaboration, continuous professional development, and research engagement in optimizing patient outcomes. By addressing these facets, healthcare providers can enhance their understanding and management of EAF, ultimately improving patient care in this intricate surgical complication.
ABSTRACT
Anastomotic leakage (AL) is the most severe and devastating complication of colorectal surgery. The objectives of this study were to identify the risk factors involved in the development of AL, evaluate diagnostic methods and explore therapeutic options in case of colorectal cancer surgery. MATERIAL AND METHODS: we conducted a retrospective study on 28 AL recorded after 315 elective colorectal cancer surgeries performed in 1st Surgery Clinic of Craiova over an 8-year period (2014-2022). RESULTS: The overall incidence of AL was 8.88%. The identified risk factors were rectal cancer (22.38%), low anterior rectal resection (50%), open approach, advanced age (82.15% over 60 years old), male sex (3:1), and the presence of two or more co-morbidities. Medical conservative treatment was the primary line of treatment in all cases. Leakage closure was achieved in 22 cases (78.56%), with exclusive conservative treatment in 15 cases (46.42%) and combined conservative and surgical treatment in 7 cases (25.0%). Overall morbidity was recorded at 64.28%, with 8 cases of general evolving complications and 10 cases of local complications. General mortality was reported at 6 (21.42%), with 3 (16.66%) occurring after conservative treatment and 3 after re-interventions (30%). CONCLUSIONS: our study identified advanced age, the presence of two or more co-morbidities, male sex, rectal surgery, and neoadjuvant chemoradiation as the most important risk factors for AL. Medical conservative treatment was the primary treatment modality, while reoperation was necessary in cases of uncontrollable sepsis and MODS. Mortality after re-intervention was nearly double compared to conservative treatment.
ABSTRACT
OBJECTIVES: The aim of the study was to present the results obtained in our experiment regarding the management of postoperative enterocutaneous fistulas (PECF). MATERIALS AND METHODS: We conducted a retrospective study on 64 PECF registered after 2030 abdominal surgeries (1525 digestive tract surgeries and 505 extra-digestive ones) over a period of 7 years (1st of January 2014-31th of December 2020) in the 1st and 2nd Surgery Clinics, Clinical County Emergency Hospital of Craiova, Romania. The group included 41 men (64.06%) and 23 women (35.34%), aged between 21-94 years. Of the cases, 71.85% occurred in elderly patients over 65 years old. Spontaneous fistulas in Crohn's disease, intestinal diverticulosis, or specific inflammatory bowel disease were excluded. RESULTS: The overall incidence of 3.15% varied according to the surgery type: 6.22% after gastroduodenal surgery, 1.78% after enterectomies, 4.30% after colorectal surgery, 4.28% after bilio-digestive anastomoses, and 0.39% after extra-digestive surgery. We recorded a 70.31% fistula closure rate, 78.94% after exclusive conservative treatment and 57.61% after surgery; morbidity was 79.68%, mortality was 29.68%. CONCLUSION: PECF management requires a multidisciplinary approach and is carried out according to an algorithm underlying well-established objectives and priorities. Conservative treatment including resuscitation, sepsis control, output control, skin protection, and nutritional support is the first line treatment; surgery is reserved for complications or permanent repair of fistulas that do not close under conservative treatment. The therapeutic strategy is adapted to topography, morphological characteristics and fistula output, age, general condition, and response to therapy.
