Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown

Background: The surgical management of enterocutaneous fistulas (ECFs) in the setting of large abdominal wall defects can be challenging. We aimed to review our experience with simultaneous single-stage ECF takedown and complex abdominal wall reconstruction (AWR). Methods: Using a prospectively collected database, patients requiring surgical management of an ECF and AWR over a 5-year period were reviewed. Results: Thirty-seven patients (mean age = 58.6 years) underwent ECF repair/AWR. The mean hernia defect size was 426 ± 192 cm². Thirty-five (95%) patients required fascial releases to achieve abdominal wall closure. Thirty-six (97%) patients had sublay biologic mesh placed to reinforce the repair. Twenty-four (65%) patients developed a surgical site infection (8 superficial, 8 deep, and 8 organ space). Four patients developed an early anastomotic leak/refistulization. With a mean follow-up of 20 months, the hernia recurrence rate was 32% (n = 12). Conclusions: The simultaneous reconstruction of ECF and complex abdominal wall defects resulted in successful single-stage management of these challenging cases in nearly 70% of patients in this series.