Negative Pressure Wound Therapy for the Treatment of the Open Abdomen and Incidence of Enteral Fistulas: A Retrospective Bicentre Analysis

Abstract

Introduction. The open abdomen (OA) is often associated with complications. It has been hypothesized that negative pressure wound therapy (NPWT) in the treatment of OA may provoke enteral fistulas. Therefore, we analyzed patients with OA and NPWT with special regard to the occurrence of intestinal fistulas. Methods. The present study included all consecutive patients with OA treated with NWPT from April 2010 to August 2011 in two hospitals. Patients' demographics, indications for OA, risk factors, complications, outcome and incidence of fistulas before, during and after NPWT were recorded. Results. Of 81 patients with OA, 26 had pre-existing fistulas and 55 were free from a fistula at the beginning of NPWT. Nine of the 55 patients developed fistulas during (n = 5) or after NPWT (n = 4). Seventy-five patients received ABThera therapy, 6 patients other temporary abdominal closure devices. Only diverticulitis seemed to be a significant predisposing factor for fistulas. Mortality was slightly lower for patients without fistulas. Conclusion. The present study revealed no correlation between occurrence of fistulas before, during, and after NWPT, with diverticulitis being the only risk factor. Fistula formation during NPWT was comparable to reports from literature. Prospective studies are mandatory to clarify the impact of NPWT on fistula formation.

A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift

“…In addition, the use of larger volumes of intraoperative peritoneal irrigation render no additional benefit for the prevention of intraabdominal sepsis, wound complications (including wound infections and evisceration episodes), or anastomotic dehiscence and enterocutaneous fistula formation events. This is also in line with the most current literature on the subject [41][42][43][44][45][46][47][48][49][50].…”

“…While there is experimental evidence of at least one benefit to the use of irrigation in trauma victims [39], our results strongly suggest an upper limit of 5L for the effluent. This has relevance for today's practice, since epidemiological evidence exist for the current use of Intraoperative Peritoneal Lavage for this indication in surgical practice [41][42][43][44][45][46][47][48][49][50]. Our trial has several limitations: Since damage control techniques were utilized when indicated (as per the contemporary accepted standard of care) it is very possible that the potential benefits and/or harms (or lack thereof) that the intervention has in this population remain unknown.…”

Management of enteroatmospheric fistula with negative pressure wound therapy in open abdomen treatment: a multicentre observational study

“…Analysing the type of cycle of negative pressure therapy, we surprisingly found that the spontaneous closure rate was 70% (7 of 10 EAFs) using intermittent settings of negative pressure, whereas in the group of patients treated with continuous pressure, 57% of EAFs closed spontaneously (12 of 21 EAFs). The mean number of NPWT dressing was 9 (SD 3⋅3; range [4][5][6][7][8][9][10][11][12][13][14][15][16]. Three patients died (18⋅8%) during NPWT in OA management.…”

Laparostomia: History of Development and Technical Aspects of Implementation

“…Однако количество пациентов, которым была применена методика Виттманна, было существенно ниже, чем при использовании прочих методик. Внутрибрюшные осложнения (абсцессы) -достоверно ниже при использовании вакуум-терапии (7,7 % -перитонит и 1,4 % -травма), кишечные свищи при использовании методики Виттманна -2,8 % [56].…”

“…Применение трансабдоминальных швов в сочетании с трубками или пуговицами, через которые проводятся наружная часть нитей, способствует уменьшению диастаза краев, однако длительное их применение также связано с определенными неудобствами в виде некрозов кожи в месте прилегания наружных частей, с прорезыванием швов. Частично эти проблемы решаются применением систем динамического сведения краев раны -ABRA-system [4,56].…”