Reduction of the closure time of postoperative enterocutaneous fistulas with fibrin sealant

AIM: To assess whether the use of fibrin sealantshortens the closure time of postoperative enterocutaneous fistulas (ECFs). METHODS: The prospective case-control study included 70 patients with postoperative ECFs with an output of < 500 mL/d, a fistulous tract of > 2 cm and without any local complication. They were divided into study (n = 23) and control groups (n = 47). Esophageal, gastric and colocutaneous fistulas were monitored under endoscopic visualization, which also allowed fibrin glue application directly through the external hole. Outcome variables included closure time, time to resume oral feeding and morbidity related to nutritional support. RESULTS: There were no differences in mean age, fistula output, and follow-up. Closure-time for all patients of the study group was 12.5 ± 14.2 d and 32.5 ± 17.9 d for the control group (P < 0.001), and morbidity related to nutritional support was 8.6% and 42.5%, respectively (P < 0.01). In patients with colonic fistulas, complete closure occurred 23.5 ± 19.5 d after the first application of fibrin glue, and spontaneous closure was observed after 36.2 ± 22.8 d in the control group (P = 0.36). Recurrences were observed in 2 patients because of residual disease. One patient of each group died during follow-up as a consequence of septic complications related to parenteral nutrition. CONCLUSION: Closure time was significantly reduced with the use of fibrin sealant, and oral feeding was resumed faster. We suggest the use of fibrin sealant for the management of stable enterocutaneous fistulas.

A review of isolated muscular ventricular septal defect

Background Color Doppler echocardiography greatly facilitates the diagnosis of isolated muscular ventricular septal defect with a small shunt.Data sources Original research articles were collected from database,including PubMed and Google scholar.Relevant articles about muscular ventricular septal defect were included.Results The frequency of isolated muscular ventricular septal defect is 5.7%in preterm infants and 1.1-5.3%in term infants.Spontaneous closure in muscular ventricular septal defect occurs with higher frequency and earlier than in perimembranous ventricular septal defect.Approximately 80-90%of isolated muscular ventricular septal defect closes spontaneously by 12 months of age.Midventricular muscular ventricular septal defect is spontaneously closed earlier in the short term,but no site difference is found in the long term.The spontaneous closure mechanism is regarded as aposition of the muscle tissueor fibrous tissue formation in the right ventricular side,but in rare cases involves aneurysm formation of the fibrous tissue.Regarding spontaneous closure of isolated muscular ventricular septal defect diagnosed for the fetus,further studies are needed.Chromosomal microarray analysis of fetuses with isolated muscular ventricular septal defect has revealed that it is not a severe risk factor of chromosomal abnormalities.Conclusions This paper presents a review of the history of the diagnosis and frequency of ventricular septal defect,with discussion of its natural history from the fetal period to after birth in patients with isolated muscular ventricular septal defect.

肠造口的自行闭合

Intestinal loop stoma is a common surgical procedure performed for various benign and malignant abdominal problems,but it rarely undergoes spontaneous closure,without surgical intervention.Two male patients presented to our emergency surgical department with acute abdominal pain.One of them was diagnosed as having rectosigmoid perforation and underwent diversion sigmoid loop colostomy after primary closure of the perforation.The other was a known case of carcinoma of the rectum who had already undergone low anterior resection with covering loop ileostomy;the patient underwent second loop ileostomy,this time for complicated intestinal obstruction.To our surprise,both the loop colostomy and ileostomy closed spontaneously at 8 weeks and 6 weeks,respectively,without any consequences.Spontaneous stoma closure is a rare and interesting event.The exact etiology for spontaneous closure remains unknown,but it may be hypothesized to result from slow retraction of the stoma,added to the concept of a tendency towards spontaneous closure of enterocutaneous fistula.