Role of Early Enteral Nutrition in the Management of Postoperative Enterocutaneous Fistula

Background: Postoperative enterocutaneous fistula (ECF) is a challenging complication that significantly impacts morbidity and mortality. Nutritional management plays a crucial role in optimizing outcomes, with early enteral nutrition (EEN) emerging as a preferred strategy over total parenteral nutrition (TPN). This study aimed to compare the effectiveness of EEN versus TPN in postoperative ECF patients. Methods: A prospective observational study was conducted at the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from July 2024 to January 2025 on 30 postoperative ECF patients. Participants were divided into two groups: early enteral nutrition (EEN) group (n=15) and total parenteral nutrition (TPN) group (n=15). Key outcome measures included fistula closure rate, time to closure, nutritional parameters (serum albumin, total protein), length of hospital stay, and incidence of complications. Results: EEN was associated with higher spontaneous fistula closure rates (66.7% vs. 40%, p=0.048), shorter closure time (22.8 ± 4.9 vs. 31.2 ± 6.3 days, p=0.002), and improved serum albumin (p=0.003). The hospital stay was significantly shorter in the EEN group (25.6 ± 5.3 vs. 36.4 ± 7.1 days, p<0.001). The incidence of infectious complications was lower in EEN (20% vs. 46.7%, p=0.037). Conclusion: EEN demonstrated superior outcomes over TPN in postoperative ECF patients, promoting faster fistula closure, better nutritional recovery, and reduced complications. These findings support the routine use of early enteral nutrition in ECF management.