Open Abdomen with Concomitant Enteroatmospheric Fistula: Attempt to Rationalize the Approach to a Surgical Nightmare and Proposal of a Clinical Algorithm

Saverio, Salomone Di; Tarasconi, Antonio; Inaba, Kenji; Navsaria, Pradeep; Catena, Fausto; Navarro, David; Mandrioli, Matteo; Vassiliu, Pantelis; Jovine, Elio; Catena, Fausto; Tugnoli, Gregorio

doi:10.1016/j.jamcollsurg.2014.11.020

Cited by 55 publications

(68 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Bobkiewicz

Walczak

Smoliński

et al. 2016

International Wound Journal

View full text Add to dashboard Cite

The management of enteroatmospheric fistula (EAF) in open abdomen (OA) therapy is challenging and associated with a high mortality rate. The introduction of negative pressure wound therapy (NPWT) in open abdomen management significantly improved the healing process and increased spontaneous fistula closure. Retrospectively, we analysed 16 patients with a total of 31 enteroatmospheric fistulas in open abdomen management who were treated using NPWT in four referral centres between 2004 and 2014. EAFs were diagnosed based on clinical examination and confirmed with imaging studies and classified into low (<200 ml/day), moderate (200-500 ml/day) and high (>500 ml/day) output fistulas. The study group consisted of five women and 11 men with the mean age of 52·6 years [standard deviation (SD) 11·9]. Since open abdomen management was implemented, the mean number of re-surgeries was 3·7 (SD 2·2). There were 24 EAFs located in the small bowel, while four were located in the colon. In three patients, EAF occurred at the anastomotic site. Thirteen fistulas were classified as low output (41·9%), two as moderate (6·5%) and 16 as high output fistulas (51·6%). The overall closure rate was 61·3%, with a mean time of 46·7 days (SD 43·4). In the remaining patients in whom fistula closure was not achieved (n = 12), a protruding mucosa was present. Analysing the cycle of negative pressure therapy, we surprisingly found that the spontaneous closure rate was 70% (7 of 10 EAFs) using intermittent setting 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 4-16). In two patients, we observed new fistulas that appeared during NPWT. Three patients died during therapy as a result of multi-organ failure. NPWT is a safe and efficient method characterised by a high spontaneous closure rate. However, in patients with mucosal protrusion of the EAFs, spontaneous closure appears to be impossible to achieve.

show abstract

Section: Resultsmentioning

confidence: 99%

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

Bobkiewicz

Walczak

Smoliński

et al. 2016

International Wound Journal

View full text Add to dashboard Cite

show abstract

“…Di Saverio et al proposed a comprehensive classification based on the combination of different criteria as anatomical location, output, exposure, and number of fistulas [ 169 ]. As a general principle, a single, superficial fistula located in the lower GI tract with a low output has a higher probability of spontaneous closure rather than multiple fistulas deep in the wound with high output [ 169 , 170 ]. According to this principle, the management should be tailored to each clinical situation and individualized accordingly.…”

Section: Methodsmentioning

confidence: 99%

“…The goal of the treatment should be focused on trying to isolate the fistula effluent and enhancing the formation of granulation tissues surrounding it. Several different techniques were described and proposed in the literature to control and treat EAF, and some attempts to standardize its management exist [ 169 , 170 ]. A patient diagnosed with EAF in the setup of OA should be treated by medical personnel familiar with this complication and its consequences.…”

Section: Methodsmentioning

confidence: 99%

The role of open abdomen in non-trauma patient: WSES Consensus Paper

et al. 2017

Self Cite

View full text Add to dashboard Cite

The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.

show abstract

“…NPWT with continuous fascial traction has proven its role as an efficient means to achieve primary fascial closure after OA [20,22,[26][27][28]. In 2014 a group of authors from Europe concluded NPWT to be the best option currently available to treat grade 3 OA with an EAF [29].…”

Section: Discussionmentioning

confidence: 99%

Entero-atmospheric fistula migration: a new management alternative for complex septic open abdomen

Pereira¹,

Duchesne²,

Concon-Filho³

et al. 2020

ait

View full text Add to dashboard Cite

The open abdomen technique is a surgical strategy used in life-threatening conditions. After recognizing the morbidity and mortality attributed to abdominal compartment syndrome (ACS), several methods were developed to avoid this complication. The primary goal of temporary abdominal closure (TAC) is to create a tension-free closure of the abdomen without increasing intra-abdominal pressure. The optimal method of TAC should contain and protect the contents of the peritoneal cavity from external contamination and injury, preserve fascia; minimize desiccation and damage to viscera, remove and quantify third space fluid; prevent loss of domain, lower bacterial count, inflammatory response, keep the patient's abdominal wall skin dry and intact; preserve the integrity of the abdominal wall, be simple to perform and maintain, provide ease of reentry and have minimal adverse physiologic effects. Negative pressure wound therapy allowed the TAC method to achieve these objectives, but the presence of enteric fistulas or entero-atmospheric fistulas is still a challenge for even the most experienced surgeon. Here we describe two new alternatives to manage the septic complex abdomen with entero-atmospheric fistula.

show abstract

Open Abdomen with Concomitant Enteroatmospheric Fistula: Attempt to Rationalize the Approach to a Surgical Nightmare and Proposal of a Clinical Algorithm

Cited by 55 publications

References 32 publications

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

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

The role of open abdomen in non-trauma patient: WSES Consensus Paper

Entero-atmospheric fistula migration: a new management alternative for complex septic open abdomen

Contact Info

Product

Resources

About