Risk factors, outcomes, and complications associated with combined ventral hernia and enterocutaneous fistula single-staged abdominal wall reconstruction

Purpose To compare two cohorts of patients; those with isolated ventral hernias (VH) and those with VH and enterocutaneous fistulas (ECF). Risk factors for surgical complications (including recurrent ECF) and outcomes during single-stage VH with ECF surgical reconstruction were analyzed. Methods A retrospective review was performed from 2008 to 2019. We compared two cohorts of patients with single-stage VH repairs: (1) ventral hernia repair alone (hernia alone), and (2) combined VH repair and ECF repair (hernia plus ECF). Inclusion criteria were patients ≥ 18 years of age with pre-operative VH either with or without an ECF, who underwent open hernia repair and ECF repair in a single-stage operation, with a minimum follow-up of 12 months. Patient risk factors, operative characteristics, outcomes and surgical-site complications were compared using univariate and multivariate analyses. Results We included 442 patients (hernia alone = 401; hernia plus ECF = 41) with a median follow-up of 22 months (12–96). Hernia plus ECF patients were more likely to have inflammatory bowel disease (IBD)(OR 4.4, 95% CI 1.1–17.5, p = 0.037), a history of abdominal wound infections (OR 3.4, 95% CI 1.5–7.9, p = 0.004), reoperations (OR 4.9, 95% CI 1.6–15.4, p = 0.006), superficial soft tissue infections (OR 2.5, 95% CI 1.1–6.1, p = 0.044) and hematomas (OR 8.4, 95% CI 1.2–58.8, p = 0.031), compared to hernia alone patients. ECF recurrence was associated with diabetes mellitus (DM) ( n = 8, 73% vs. n = 6, 20%; p = 0.003) and surgical-site complications ( n = 10, 91% vs. n = 16, 53%; p = 0.048), compared to ECF resolution. Conclusion Risk factors for developing ECF were IBD and history of abdominal wound infections. Single-staged combined ECF reconstruction was associated with reoperations, soft tissue infections and hematomas. DM and surgical-site complications were associated with ECF recurrence.