Name of the Procedure:

Closure of Intestinal Cutaneous Fistula
Common names: Fistula Repair Surgery, Enterocutaneous Fistula Closure
Technical terms: Surgical Repair of Enterocutaneous Fistula

Summary

Closure of intestinal cutaneous fistula is a surgical procedure to repair an abnormal connection (fistula) between the intestine and the skin. This connection causes bowel contents to leak through the skin, necessitating surgical intervention to close the tract and restore normal intestinal function.

Purpose

Addresses: Abnormal communication between the intestine and skin surface.
Goals:

• Prevent leakage of intestinal contents
• Reduce risks of infections and skin irritation
• Restore normal bowel function

Indications

• Persistent drainage from the fistula site
• Delay in natural healing (usually beyond 6 weeks)
• Infections or skin irritation around the fistula
• Poor nutrition or dehydration due to ongoing fistula drainage

Preparation

• Fasting: Patients may need to fast for 8-12 hours before surgery.
• Medications: Adjustments in current medications as advised by the doctor.
• Tests: Blood tests, imaging studies (CT scan, X-ray), and nutritional assessment to evaluate overall health and readiness for surgery.

Procedure Description

1. Anesthesia: The patient is given general anesthesia.
2. Incision: A surgical incision is made near the fistula site.
3. Dissection: The surgeon carefully dissects through tissues to locate the fistula tract.
4. Repair: The intestine is separated from the skin, and the fistula tract is closed, typically with sutures or surgical staples.
5. Wound Closure: The incision is closed using sutures or staples.
6. Infection Prevention: Antibiotics may be administered to prevent infections.

Duration

The procedure typically takes 2-4 hours, depending on the complexity of the fistula.

Setting

This surgery is usually performed in a hospital operating room.

Personnel

• Surgeons: A general surgeon or a colorectal specialist.
• Nurses: Operating room nurses and surgical assistants.
• Anesthesiologists: For administration and monitoring of anesthesia.
• Post-operative Care Team: Including recovery room nurses and hospitalists.

Risks and Complications

Common Risks:

• Infections
• Bleeding
• Pain at the surgical site

Rare Risks:

• Fistula recurrence
• Damage to surrounding organs
• Complications from anesthesia

Management: Risks are managed with antibiotics, pain relief, and close monitoring by the healthcare team.

Benefits

• Effective closure of the fistula
• Reduction in discomfort and skin irritation
• Improved nutritional status and overall well-being
• Return to regular bowel function

Timeframe for Benefits: Benefits can be realized within weeks to months post-surgery, depending on individual recovery.

Recovery

• Post-care: Instructions include wound care, dietary modifications, and activity restrictions.
• Time: Recovery typically takes 4-6 weeks.
• Restrictions: Avoid heavy lifting and strenuous activities. Follow a prescribed diet.
• Follow-Up: Scheduled visits for wound inspection and to monitor healing.

Alternatives

• Conservative Management: Including wound care, nutritional support (less effective for complex cases).
• Pros: Non-invasive, less immediate risk.
• Cons: Prolonged healing, potential for recurrent infections.

Patient Experience

• During the Procedure: The patient will be unconscious under general anesthesia and will not feel pain.
• After the Procedure: Pain and discomfort managed with medications. Some patients might experience mild discomfort at the incision site.
• Comfort Measures: Pain relief, sleeping aids, and supportive care to ensure comfort during recovery.