[Enterocutaneous fistulas--persisting conditions but the healing capacity can be surgically restored. Current treatment and surgical skills reduce the mortality]. / Enterokutana fistlar--krävande tillstånd som kan opereras till läkning. Modern behandling och kirurgisk erfarenhet minskar mortaliteten.

Persisting enterocutaneous fistulae are difficult to treat. Mortality and morbidity are high. Patients are characterized by chronic infection, systemic inflammation, catabolism and impaired healing. During 1988-2002 69 patients were operated at the University Hospital, Linköping. The mortality was 18% in 1988 to 1996 but decreased to 7% in 1997 to 2002 after establishment of present treatment strategies. It's main feature is staged surgery rising ostomies rather than doing primary anastomoses. The ostomies are closed several months later when infection and systemic inflammation are overcome and nutrition and healing capacity are restored. All patients that survived healed their fistula after surgery. Open abdomen, high output fistulas, impaired liver function and a low serum albumin were associated with a poor prognosis for healing and mortality. Effective techniques for management of abdominal defects, methods to establish enteral nutrition, minimize chronic inflammation and liver impairment as well as operative techniques and strategies are important.