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January 2010

Defining an Enterocutaneous Fistula—Reply

Arch Surg. 2010;145(1):103. doi:10.1001/archsurg.2009.232

In reply

We thank Dr Maa for his interest in our article and for his insightful comments. Regarding Table 2, there were 4 recurrences at 7 to 12 weeks (27%), rather than 2 as stated in the table; the recurrence rate prior to 36 weeks was 12 of 104 cases (12%), as stated in the article. We regret the error. We defined enterocutaneous fistula as any abnormal communication of the intestinal lumen with the skin surface. We concur that definitive operative therapy should not be performed in the setting of an uncontrolled fistula, and it is our practice when possible to wait at least 12 weeks to optimize operative conditions. An earlier operation was performed only when needed for intra-abdominal abscesses or anastomotic leak and peritonitis. We agree that anastomotic leak is a technical failure, but it still resulted in the development of an enterocutaneous fistula in the cases reported. Radiologic procedures were used in all patients in whom the infection was amenable to percutaneous drainage. Nonoperative management was not an option for patients presenting with generalized peritonitis and sepsis. As the great majority of these procedures were referred to and performed by a single surgeon (H.G.C.) with considerable experience in the treatment of this challenging condition, we do not believe that a volume-outcome relationship was present.

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