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Wang XT, Wang L, Liu AL, Huang JL, Li L, Lu ZX, Mai W. New application of intestinal obstruction catheter in enterocutaneous fistula: A case report. World J Clin Cases 2024; 12:4384-4390. [PMID: 39015899 PMCID: PMC11235536 DOI: 10.12998/wjcc.v12.i20.4384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and the skin. ECF can lead to massive body fluid loss, hypercatabolism, and malnutrition. Therefore, nutritional support plays a crucial role in managing ECFs and promoting the healing of fistulas. For nutritional support, enteral nutrition (EN) is the preferred method when gastrointestinal function is recovering. Currently, various EN approaches have been applied for different anatomical positions of the ECF. However, the effectiveness of administering EN support for treating lower ECFs still needs further exploration and improvement. CASE SUMMARY We present the case of a 46-year-old male who underwent gastrointestinal stromal tumour resection. Six days after the surgery, the patient presented with fever, fatigue, severe upper abdominal pain, and septic shock. Subsequently, lower ECFs were diagnosed through laboratory and imaging examinations. In addition to symptomatic treatment for homeostasis, total parenteral nutrition support was administered in the first 72 h due to dysfunction of the intestine. After that, we gradually provided EN support through the intestinal obstruction catheter in consideration of the specific anatomic position of the fistula instead of using the nasal jejunal tube. Ultimately, the patient could receive optimal EN support via the catheter, and no complications were found during the treatment. CONCLUSION Nutritional support is a crucial element in ECF management, and intestinal obstruction catheters could be used for early EN administration.
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Affiliation(s)
- Xiao-Tong Wang
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Long Wang
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - An-Lin Liu
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jing-Le Huang
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Lei Li
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zhi-Xing Lu
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Wei Mai
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Chipu MG, Kearns I, Modula MJ. Exploration of critical care nurses' challenges in caring for enterocutaneous fistula as a complication for an open abdomen: A qualitative study. Health Sci Rep 2024; 7:e2051. [PMID: 38742090 PMCID: PMC11089839 DOI: 10.1002/hsr2.2051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/29/2024] [Accepted: 03/20/2024] [Indexed: 05/16/2024] Open
Abstract
Background and Aims Enterocutaneous fistula is a severe complication of an open abdomen, which poses devastating challenges for critical care nurses. The study aimed to explore and describe the challenges faced by critical care nurses caring for patients with enterocutaneous fistulas in a tertiary public hospital in Gauteng, South Africa. Methods A qualitative, exploratory, descriptive, and contextual design was conducted to understand the challenges experienced by the critical care nurses caring for patients with enterocutaneous fistulas. The standards for reporting qualitative research checklists are utilized. The study conducted four semistructured focus group interviews with six members in each group. Results Critical care nurses revealed two overarching themes: the challenges regarding difficult nursing care and the lack of resources to provide quality patient care. Care of patients with ECF highlighted that nurses were not coping with the care of such patients. Conclusion Collaboration of a multidisciplinary team involving dieticians, surgeons, and enterostomal therapy nurses could improve the management of ECF without surgical intervention, increase the knowledge and skills of nurses, alleviate their challenges, and yield safe patient outcomes. Standardized and updated protocols will ensure the best practices toward quality patient care that facilitate healing, closure, and reducing mortality and morbidity rates. The key principles for caring for patients with open abdomen, presenting with enterocutaneous fistulas, are based on correcting fluids and electrolytes, nutritional optimization and support, control of abdominal sepsis, wound care management, pain control, and emotional support to critical care nurses and ward nurses.
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Management of enteroatmospheric fistula: A ten-year experience following fifteen years of learning. Surgery 2023; 173:1079-1085. [PMID: 36653234 DOI: 10.1016/j.surg.2022.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/20/2022] [Accepted: 12/11/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Enteroatmospheric fistulas are a serious complication of Open Abdomen. The goal of this study was to present the strategy and results of enteroatmospheric fistulas treatment during the last 10 years, after a long learning period. METHODS Seventy-seven patients with enteroatmospheric fistulas were treated and the data recorded between 2012 and 2021. For local treatment, 3 negative pressure methods were used, according to the wound characteristics. The results of conservative and surgical treatments were retrospectively identified and described, including nutritional recovery, morbidity and mortality. Predictors of spontaneous closure, as well as risk factors for the fistula's recurrence and mortality were analyzed. RESULTS Nutritional and clinical recovery was achieved in 66 patients (85.7%). Fourteen patients (18%) were healed without surgery after a median of 57 days (range 35-426 days). Unique lesions (13/46; P = .02, OR 10.23), initial output ≤700 mL/day (9/28; P = .0035, OR 3.79) and deep fistulas (9/12; P = .00001, OR 33.6) were encountered and acknowledged to be as spontaneous closure factors. Fifty-six patients (72.7%) required reconstructive surgery of the intestinal tract after a median of 187 days since last laparotomy (range: 63-455 days). There were 9 postoperative recurrences (16%), 5 of them closed with conservative treatment. No significant risk factors for recurrence nor postoperative mortality were found. Fistula complete closure was achieved in 63 of the 77 patients studied (81.8%), and 7 patients died (9%). CONCLUSION The combination of 3 vacuum methods used for enteroatmospheric fistula management was effective. Spontaneous closure of an enteroatmospheric fistula is unlikely but feasible when lesions are single, deep, with limited output, and when intestinal continuity is preserved. Surgical indications are well defined, although mortality and recurrence rates are still high.
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nikoupour H, Theodorou A, Arasteh P, Lurje G, Kalff JC, von Websky MW. Update on surgical management of enteroatmospheric fistulae in intestinal failure patients. Curr Opin Organ Transplant 2022; 27:137-143. [PMID: 35232927 DOI: 10.1097/mot.0000000000000960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The surgical management of enteroatmospheric fistula (EAF) in patients with intestinal failure represents a major challenge for a surgical team and requires proficiency in sepsis management, nutritional support and prehabilitation, beside expertise in visceral and abdominal wall surgery. This review provides an update on the current recommendations and evidence. RECENT FINDINGS Reconstructive surgery should be performed at a minimum of 6-12 months after last laparotomy. Isolation techniques and new occlusion devices may accelerate spontaneous EAF closure in selected cases. Chyme reinfusion supports enteral and parenteral nutrition. Stapler anastomosis and failure to close the fascia increase the risk of EAF recurrence. Posterior component separation, intraoperative fascial tension and biological meshes may be used to accommodate fascial closure. SUMMARY Timing of reconstructive surgery and previous optimal conservative treatment is vital for favorable outcomes. Wound conditions, nutritional support and general patient status should be optimal before attempting a definitive fistula takedown. Single stage procedures with autologous gut reconstruction and abdominal wall reconstruction can be complex but well tolerated.
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Affiliation(s)
- Hamed Nikoupour
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Peyman Arasteh
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Georg Lurje
- Department of Surgery, Charité Berlin, Berlin, Germany
| | - Joerg C Kalff
- Department of Surgery, University Hospital of Bonn, Bonn
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Couper C, Doriot A, Siddiqui MTR, Steiger E. Nutrition Management of the High-Output Fistulae. Nutr Clin Pract 2020; 36:282-296. [PMID: 33368576 DOI: 10.1002/ncp.10608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/31/2020] [Indexed: 11/05/2022] Open
Abstract
Enterocutaneous fistulae (ECFs) are commonly encountered complications in medical and surgical practice. High-output fistulae are associated with significant morbidity and mortality, poor quality of life, and a substantial healthcare burden. An interdisciplinary team approach is crucial to prevent and mitigate the adverse clinical consequences of high-output ECFs including sepsis, metabolic derangements, and malnutrition. Patients with ECFs are at a significantly higher risk of developing malnutrition and close monitoring by nutrition support professionals and/or a nutrition support team is an essential component of their medical management. High-output ECFs often require the initiation of nutrition support through either enteral or parenteral routes. Historically, parenteral nutrition (PN) has been the primary method of nutrition support in these patients. However, oral and enteral nutrition (EN) should remain viable options if an evaluation of the location of the ECF, amount of remaining functional bowel, and volume of ECF output identifies favorable conditions. Additionally, in contrast to PN, oral nutrition and EN are the preferred method of feeding because of the maintenance of the structural and functional integrity of the gastrointestinal tract. The inclusion of pharmacological interventions can greatly assist with the reduction and stabilization of ECF output and thereby permit sustained enteral feeding. Initiation of supplemental or full PN will be required if oral nutrition and EN lead to metabolic derangements, fail to meet energy requirements, or do not maintain or improve the patient's nutrition status. The main focus of this review is to discuss the nutrition management of patients with high-output ECFs.
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Rosas-Flota X, Castillo-Martínez L, Reyes-Ramírez AL, Martínez-Soto Holguín MC, Serralde-Zúñiga AE. Adaptation of the medical-nutrition therapy for patients with intestinal failure in a developing country: A modified Delphi survey. Clin Nutr ESPEN 2020; 40:187-192. [PMID: 33183535 DOI: 10.1016/j.clnesp.2020.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/12/2020] [Accepted: 09/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Intestinal Failure (IF) is a complex disease with huge impacts on our society due to complications. Therefore, in a developing country like Mexico without specialized IF clinics, health care professionals must provide evidence-based interventions for the IF patient. This study aims to achieve consensus on how to adapt the existing guidelines for IF to the local practices considering the available resources and local practices. METHODS A three-round modified Delphi process was used to build consensus on the most important interventions for our IF patients. For each round, data was collected and consensus was defined as ≥80% of agreement for each item. Descriptive statistics were used to determine whether a consensus was achieved. RESULTS Ten content experts completed the three-round modified Delphi survey. Consensus was achieved for 98% of the items related to the hospitalized patient, ambulatory care management, and drug therapy. Some of these items are not included in the ESPEN guidelines for IF, but we considered that they are relevant in our clinical practice, like the calculation of fluids for patients with very low body weight, screening for refeeding syndrome and the use of some conventional drugs to promote intestinal rehabilitation. CONCLUSIONS Using a three-round modified Delphi process, consensus was achieved for nearly all items. This represents a starting point for the improvement of our local practices towards this complex disease, leading to better outcomes and the implementation of evidence-based protocolized interventions which can have an important impact due to the lack of access to some of the most novel pharmacological therapies like the glucagon-like-peptide (GLP-2) analog.
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Affiliation(s)
- Ximena Rosas-Flota
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Universidad Nacional Autónoma de México, Facultad de Medicina, Div. Estudios de Posgrado, Mexico.
| | - Lilia Castillo-Martínez
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Ana L Reyes-Ramírez
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | | | - Aurora E Serralde-Zúñiga
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Tang QQ, Hong ZW, Ren HJ, Wu L, Wang GF, Gu GS, Chen J, Zheng T, Wu XW, Ren JA, Li JS. Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression. Front Nutr 2020; 7:564379. [PMID: 33123545 PMCID: PMC7573310 DOI: 10.3389/fnut.2020.564379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022] Open
Abstract
The management of enterocutaneous fistulas (ECF) can be challenging because of massive fluid loss, which can lead to electrolyte imbalance, severe dehydration, malnutrition and sepsis. Nutritional support plays a key role in the management and successful closure of ECF. The principle of nutritional support for patients with ECF should be giving enteral nutrition (EN) priority, supplemented by parenteral nutrition if necessary. Although total parenteral nutrition (TPN) may be indicated, use of enteral feeding should be advocated as early as possible if patients are tolerant to it, which can protect gut mucosal barrier and prevent bacterial translocation. A variety of methods of enteral nutrition have been developed such as fistuloclysis and relay perfusion. ECF can also be occluded by special devices and then EN can be implemented, including fibrin glue application, Over-The-Scope Clip placement and three-dimensional (3D)-printed patient-personalized fistula stent implantation. However, those above should not be conducted in acute fistulas, because tissues are edematous and perforation could easily occur.
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Affiliation(s)
- Qin-Qing Tang
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China.,Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhi-Wu Hong
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Hua-Jian Ren
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Lei Wu
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Ge-Fei Wang
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Guo-Sheng Gu
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Jun Chen
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Tao Zheng
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Xiu-Wen Wu
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Jian-An Ren
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
| | - Jie-Shou Li
- Jinling Hospital Research Institute of General Surgery, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Jinling Hospital, Nanjing, China
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Papa A, Lopetuso LR, Minordi LM, Di Veronica A, Neri M, Rapaccini G, Gasbarrini A, Papa V. A modern multidisciplinary approach to the treatment of enterocutaneous fistulas in Crohn's disease patients. Expert Rev Gastroenterol Hepatol 2020; 14:857-865. [PMID: 32673498 DOI: 10.1080/17474124.2020.1797484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Enterocutaneous fistulas (ECFs) is a manifestation of penetrating Crohn's disease (CD) that is challenging to treat and has considerable morbidity and mortality rates. AREAS COVERED This review aims to explore the practical and updated principles for the optimal treatment of ECFs in CD patients. EXPERT OPINION Optimal ECF management requires a multidisciplinary approach. Treatment first includes fluid resuscitation and electrolyte rebalancing with control of sepsis by means of antibiotics and, when indicated, drainage of infected collections. Subsequent therapeutic steps include nutritional support, control of the fistula output and treatment of peristomal skin. Anti-TNF-α therapy seems to have limited utility only after sepsis is resolved and intestinal stenosis excluded. However, ECFs heal in only approximately one-third of cases without surgical intervention. Thus, correct surgical timing combined with adequate nutritional support, sepsis resolution and skin care is considered the appropriate preoperative setting.
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Affiliation(s)
- Alfredo Papa
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS , Roma, Italy.,Università Cattolica del Sacro Cuore , Roma, Italia
| | - Loris Riccardo Lopetuso
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS , Roma, Italy.,Department of Medicine and Ageing Sciences, "G. d'Annunzio" University of Chieti-Pescara , Chieti, Italy.,Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara , Chieti, Italy
| | - Laura Maria Minordi
- Dipartimento di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia
| | - Alessandra Di Veronica
- Dipartimento di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia
| | - Matteo Neri
- Department of Medicine and Ageing Sciences, "G. d'Annunzio" University of Chieti-Pescara , Chieti, Italy.,Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara , Chieti, Italy
| | - Gianludovico Rapaccini
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS , Roma, Italy.,Università Cattolica del Sacro Cuore , Roma, Italia
| | - Antonio Gasbarrini
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS , Roma, Italy.,Università Cattolica del Sacro Cuore , Roma, Italia
| | - Valerio Papa
- Università Cattolica del Sacro Cuore , Roma, Italia.,Dipartimento di Chirurgia, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia
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Martinez JL, Bosco-Garate I, Souza-Gallardo LM, Méndez JD, Juárez-Oropeza MA, Román-Ramos R, Ferat-Osorio E. Effect of Preoperative Administration of Oral Arginine and Glutamine in Patients with Enterocutaneous Fistula Submitted to Definitive Surgery: a Prospective Randomized Trial. J Gastrointest Surg 2020; 24:426-434. [PMID: 30710211 DOI: 10.1007/s11605-018-04099-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/28/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of glutamine and arginine has shown several advantages in postoperative outcomes in patients after gastrointestinal surgery. We determined the effects of its use in patients with enterocutaneous fistula after operative treatment. PATIENTS AND METHODS Forty patients with enterocutaneous fistula were randomly assigned to one of two groups. The control group received the standard medical care while the patients of the experimental group were supplemented with enteral administration of 4.5 g of arginine and 10 g of glutamine per day for 7 days prior to the surgery. The primary outcome variable was the recurrence of the fistula and the secondary outcomes were preoperative and postoperative serum concentrations of interleukin 6 and C-reactive protein and postoperative infectious complications. RESULTS Twenty patients were assigned to each group. The fistula recurred in two patients (10%) of the experimental group and in nine patients (45%) of the control group (P < 0.001). We found a total of 13 infectious complications in six patients of the control group (all with fistula recurrence) and none in the experimental group. Mean preoperative serum concentrations of interleukin 6 and C-reactive protein were lower in patients from the experimental group. In addition, these levels were lower in patients who had recurrence if compared to patients that did not recur. CONCLUSION Preoperative administration of oral arginine and glutamine could be valuable in the postoperative recovery of patients with enterocutaneous fistulas submitted to definitive surgery.
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Affiliation(s)
- Jose L Martinez
- Department of General and Gastrointestinal Surgery, UMAE Hospital de Especialidades - Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Mexico City, Mexico
- Programa de Doctorado en Ciencias Biológicas, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
| | - Ilka Bosco-Garate
- Unidad de Investigación Médica en Inmunoquímica, UMAE Hospital de Especialidades - Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Av.Cuauhtémoc 330, 3er piso, Colonia Doctores, Delegación Cuauhtémoc, 06720, Mexico City, Mexico
| | - Luis Manuel Souza-Gallardo
- Department of General and Gastrointestinal Surgery, UMAE Hospital de Especialidades - Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Mexico City, Mexico
| | - José D Méndez
- Unidad de Investigación Médica en Enfermedades Metabólicas, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Mexico City, Mexico
| | | | - Ruben Román-Ramos
- División Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
| | - Eduardo Ferat-Osorio
- Department of General and Gastrointestinal Surgery, UMAE Hospital de Especialidades - Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Mexico City, Mexico.
- Unidad de Investigación Médica en Inmunoquímica, UMAE Hospital de Especialidades - Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Av.Cuauhtémoc 330, 3er piso, Colonia Doctores, Delegación Cuauhtémoc, 06720, Mexico City, Mexico.
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