The importance of reconstruction of the abdominal wall after gastrointestinal fistula closure

Operation for gastrointestinal cutaneous fistula almost always requires resection and anastomosis. Those of use who do this surgery frequently have learned the hard way that closure of the abdominal wall, preferably with native tissue, is essential for refistulization to not occur. What is one to do when component separation or an Abramson type of approach is insufficient and flaps either can not be done or are not available? Recently, it has been proposed that inert biological material may be the answer for abdominal closure and somehow it is more resistant to infection and less likely to fistulize than totally synthetic material. However, data has slowly been coming available that suggests that use of inert biological material may in fact not be satisfactory and may in fact have an increased tendency to infection, wound breakdown, and refistulization.