Strategies to Manage a Complex Reoperative Abdomen and Enterocutaneous Fistulas

H. Hande Aydinli, MD; Michael J. Grieco, MD, FACS; Hasan T. Kirat, MD; Feza H. Remzi, MD, FACS

Product Details
Product ID: ACS-5527
Year Produced: 2018
Length: 9 min.


Reoperative surgery for enterocutaneous fistulas (ECF) involving the small bowel remains a challenging surgical problem. We present two cases of complex ECF with the demonstration of reoperative surgery principles. A 75 years old female with a history of cervical cancer and brachytherapy presents after multiple abdominal surgeries with a high output ECF, and a 55 years old male status post robotic paraesophageal hernia repair with mesh and Collis gastroplasty complicated with anastomotic leak who required multiple reoperations presents with a high output ECF. Starting the dissection from the easiest part of the pathology, finding a plane that was not violated before, using hydrodissection to avoid enterotomies and clear adhesions, using penrose drains to fill infected cavities, intraoperative insufflation test to identify iatrogenic enterotomies, using high jejunostomy and TPN are some of the main principles will be mentioned in the video.