Cierre de fístulas enterocutáneas en pacientes con hernias ventrales incisionales: La reconstrucción de pared abdominal en una o en dos etapas. Revisión de la literatura

Introduction. Enterocutaneous fistulas represent an important cause of morbidity and mortality in patients who have undergone surgery on multiple occasions. In 29% of patients, they are associated with an incisional hernia. There is controversy regarding the closure of the enterocutaneous fistula simultaneously with the reconstruction of the abdominal wall, due to the different results obtained in the studies carried out in this regard. Methods. A search was performed in PubMed via Medline to perform a narrative review of the updated literature, including the main studies of enterocutaneous fistula closure and abdominal wall reconstruction on the one-stage and two-stage strategy. Results. There is evidence for and against both strategies. The studies are very heterogeneous and have biases that prevent a clear recommendation from being given. It is vitally important to individualize each patient and make decisions on a case-by-case basis. Conclusions. The one-stage strategy may be feasible when there are abdominal wall defects smaller than 10 cm, the fistula is not complex, there is little contamination, comorbidities are controlled, and the patient can endure prolonged surgery. Otherwise, a two-stage strategy is recommended.