Determining the Effect of Preoperative Administration of Oral Arginine and Glutamine in Patients with Enterocutaneous Fistula Subjected to Definitive Surgery: A Prospective Randomized Trial

Background: Management of enterocutaneous fistulas (ECFs) is a complex and challenging problem commonly found by general and specialized surgeons. Recently, some nutrients have been used to improve the immune system of patients who are subjected to gastrointestinal surgery. The use of glutamine and arginine has shown several advantages in postoperative outcomes in patients after gastrointestinal surgery.

The objective of this study was to determine the effect of the preoperative administration of enteral glutamine and arginine in patients submitted to surgical repair of their ECF regarding recurrence, inflammatory cytokines, and infectious complications.

Patients and Methods: Forty patients with enterocutaneous fistula were randomly assigned to one of two groups. The control group received the standard medical care while the patients of the experimental group were supplemented with enteral administration of 4.5 g of arginine and 10 g of glutamine per day for 7 days prior to 3the surgery. All the collected data was analyzed using GraphPad Prism and SPSS. The primary outcome variable was the recurrence of the fistula and the secondary outcomes were preoperative and postoperative serum concentrations of interleukin 6 and C-reactive protein and postoperative infectious complications.

Results: Twenty patients were assigned to each group. The fistula recurred in two patients (10%) of the experimental group and in nine patients (45%) of the control group (P < 0.001). We found a total of 13 infectious complications in six patients of the control group (all with fistula recurrence) and none in the experimental group. Mean preoperative serum concentrations of interleukin 6 and C-reactive protein were lower in patients from the experimental group. In addition, these levels were lower in patients who had recurrence if compared to patients who did not recur. The results of this study show that the preoperative use of oral arginine and glutamine in patients with ECF has positive effects about fistula recurrence, postoperative inflammatory markers, and infectious complications after definitive surgery (fistula resection and primary anastomosis).

Conclusion: Most patients with ECF require definitive surgical treatment for its closure. Preoperative administration of oral arginine and glutamine could be valuable in the postoperative recovery of patients with enterocutaneous fistulas submitted to definitive surgery.