Surgical techniques for the management of enteroatmospheric fistulae.
BACKGROUND
An intestinal fistula in the "open abdomen" is called "enteroatmospheric" and is a great challenge for the surgeon because of the high mortality and morbidity rates associated with it. This report is a study of the surgical strategy for treating patients with enteroatmospheric fistulae.


METHODS
During a 3-year period (2005-2007), two males and one female patient with a mean age of 63 years were referred to our surgical department for management of enteroatmospheric fistulae that developed after operations carried out for severe peritonitis, which was a consequence of sigmoid diverticulum rupture in two cases and disruption of an entero-enteric Roux-en-Y anastomosis after total gastrectomy for cancer in one.


RESULTS
All patients were appropriately supported in a surgical intensive care unit, with administration of total parenteral nutrition and appropriate antibiotics to eliminate secondary infections. Several re-operations were necessary to treat the enteroatmospheric fistulae. Eventually, all patients were discharged after a lengthy hospital stay (45-145 days).


CONCLUSIONS
The essential principles of our operative strategy are: (1) early intervention; (2) a lateral surgical approach via the circumference of the open abdomen to avoid further damage to the exposed viscera; (3) excision of the involved bowel loop with an end-to-end anastomosis; (4) temporary abdominal closure and coverage of the open abdomen with an absorbable mesh, promoting tissue granulation; (5) skin grafting attempts; and (6) selective use of vacuum-assisted closure.
Marinis
Athanasios
A
Second Department of Surgery, Aretaieion University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Gkiokas
Georgios
G
Anastasopoulos
Georgios
G
Fragulidis
Georgios
G
Theodosopoulos
Theodosios
T
Kotsis
Thomas
T
Mastorakos
Dimitrios
D
Polymeneas
George
G
Voros
Dionisios
D
D000328:Adult; D000368:Aged; D003161:Compartment Syndromes / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D016038:Skin Transplantation / Q000379:methods; D013526:Surgical Mesh