Novel Approach for Enterocutaneous Fistula Treatment with the Use of Viable Cryopreserved Placental Membrane

Abstract

Enterocutaneous fistulas (ECF) are a difficult and costly surgical complication to manage. The standard treatment of nil per os (NPO) and total paraenteral nutrition (TPN) is not well tolerated by patients. TPN is also known for complications associated with long term central venous catheterization and for high cost of prolonged hospital stay. We present two low output ECF cases successfully treated with viable cryopreserved placental membrane (vCPM) placed into the fistula tracts. One patient is a 59-year-old male with a low output ECF from a jejunostomy tube site four weeks after the surgery. The second patient is an 87-year-old male with a low output ECF following a small bowel resection secondary to a strangulated inguinal hernia. He was evaluated on day 41 after surgery. NPO and TPN for several weeks did not resolute the ECF. The fistulae were closed postoperatively in both patients with zero output on the same day after one vCPM application. On day 3 postoperatively both patients were started on clear liquid diets and subsequently advanced to regular diets. The ECF have remained resolved for over 2 months. The use of vCPM is a novel promising approach for treatment of ECF.

Placental Membranes for Management of Refractory Cutaneous Sinus Tracts of Surgical Origin: A Pilot Study

“…A recent surgical report by Nichols & Overly presented successful treatment of refractory low-output enterocutaneous fistulas without recurrence using a single application of vCPM. 39 In a prospective multicenter clinical trial, vCPM showed clinical benefits in the management of complex diabetic foot ulcers with exposed bone and tendon. 40 Results of this trial were confirmed by a head-to-toe complex wound case series.…”

Successful treatment of enteroatmospheric fistulas in combination with negative pressure wound therapy: Experience on 3 cases and literature review

“…The main goal of all these different techniques is the isolation of the fistula opening from the open abdominal wound. In a clean wound without faecal contamination surrounding the EAF, there is an approximately 50% chance of spontaneous closure of the EAF, which is comparable with the few reported long‐term successful endoscopic closure rates . On the other hand, the use of NPWT with fistula isolation for EAF management has the advantage of combined treatment of the wound and the EAF …”

“…Besides SFA and SLS, a variety of other techniques and tools are described for the successful fistula isolation of EAF from the rest of the wound using the NPWT in an open abdomen situation . Recently, new endoscopic treatment options for the management of EAF have been described.…”

“…A large case series of 47 patients with different kinds of enteric fistulae used a so‐called over‐the‐scope clip device for fistula closure in all parts of the digestive tract, with a success rate of about 50% during a half‐year follow up . A further aspect of the endoscopic technique is the use of biological plugs or cryopreserved connective tissue patches with good initial success rates of up to 90% of EAF closure, but no data about further course, recurrence rate, or time of follow up is available . The endoscopic therapeutic strategies have the advantage of being less‐invasive procedures, and the initial success rates are very good.…”

“…Nevertheless, valid data about long‐term results demonstrate high recurrence rates of almost 50% . Furthermore, secondary to inflammation, endoscopic manipulation appears to harm the bowel . Depending on the extent of the abdominal wound surrounding the former EAF opening, an additional NPWT might be necessary for appropriate wound care.…”