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Sepsis remains the main cause of morbidity and mortality in patients with enterocutaneous fistulas (ECF). Although preoperative immunonutrition has shown less infectious complications (IC) in patients with gastrointestinal malignancies submitted to operative treatment, no studies have been done regarding use of these agents in patients with ECF. Our aim was to assess the effects of preoperative enteral glutamine and arginine in patients with ECF who require surgical attempts for its closure.
Patients and Methods: During a 24 month study period, 38 patients with ECF were operated upon. All had at least 100 cm of proximal small bowel. They were divided in 2 groups: patients in group A (control, n=20) were managed with our standard preoperative protocol; patients in group B (experimental, n=18) received oral glutamine (4.5 g/day) and arginine (10 g/day) preoperatively for 7 days. Patient, disease, and operative variables were prospectively collected. Our primary endpoint was IC. Secondary endpoints included ECF recurrence, definitive ECF healing and mortality. Comparisons were made using Students T test for continuous variables and chi-square or Fischers exact test for categorical variables.
Results: All patient, disease and operative variables were similar for both groups. IC developed in 8 and 2 patients (groups A and B respectively, p=0.06). Some patients in group A had more than one IC and thus this difference became more evident when total number of complications per group were calculated (15 vs 2 respectively, p<0.05). Comparing secondary endpoints for patients in group A vs B, ECF recurred in 8 and 2, respectively (p=0.06), and definitive ECF closure was achieved in 12 and 16, respectively (p=0.06). Three patients died in group A, and 1 in group B (from an unrelated non-septic cause), p=0.60
Conclusions: Use of preoperative enteral glutamine and arginine seems to provide beneficial effects for patients with ECF submitted to operative treatment. There were less number of total IC and a clear tendency towards less number of patients with IC, less ECF recurrence and more definitive ECF closures and healing.