Surgical strategy for complex perineal small bowel fistula after pelvic malignancy: An etiology-driven approach

Table 4 Postoperative clinical outcomes, n (%)/median (minimum-maximum)/mean ± SD

Outcome measure	Group 1: Reconstruction (n = 15)	Group 2: Plication (n = 13)	Total (n = 28)	P value
Fistula closure rate	13 (86.7)	12 (92.3)	25 (89.3)	1.0
Duration of follow-up/OS in months1	32.0 (9.0-107.0)	37.0 (11.0-57.0)	34.5 (9.0-107.0)	0.66
90-day mortality	1 (6.7)	1 (7.7)	2 (7.1)	1.0
Postoperative flatus in days	4.2 ± 1.5	6.8 ± 2.1	5.4 ± 2.2	0.0021
Complications, by Clavien-Dindo				0.65
Grade I-II: Minor	4 (26.7)	5 (38.5)	9 (32.1)
Grade III-IV: Major	4 (26.7)	3 (23.1)	7 (25.0)
Stoma status at discharge
Stoma free/reversed	3 (20.0)	1 (7.7)	4 (14.3)
Permanent/temporary stoma	12 (80.0)	12 (92.3)	24 (85.7)

¹Continuous variables are presented as the mean ± SD; P-value is from the Student’s t-test.

Summary of critical postoperative outcomes. Both techniques demonstrated exceptionally high success rates in achieving durable fistula closure with no statistical superiority. However, group 2 (plication) experienced significantly longer time to flatus, consistent with the postoperative ileus often being associated with extensive intestinal manipulation. Continuous variables are presented as the median (range) due to non-normal distribution; P-values were calculated using the two-sample Wilcoxon/Mann-Whitney U test. OS: Overall survival.