title: Surgical techniques for the management of enteroatmospheric fistulae.
abstract: 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.
authors.affiliation: Second Department of Surgery, Aretaieion University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Marinis
authors.forename: Georgios
authors.initials: G
authors.lastname: Gkiokas
authors.forename: Georgios
authors.initials: G
authors.lastname: Anastasopoulos
authors.forename: Georgios
authors.initials: G
authors.lastname: Fragulidis
authors.forename: Theodosios
authors.initials: T
authors.lastname: Theodosopoulos
authors.forename: Thomas
authors.initials: T
authors.lastname: Kotsis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Mastorakos
authors.forename: George
authors.initials: G
authors.lastname: Polymeneas
authors.forename: Dionisios
authors.initials: D
authors.lastname: Voros
mesh_terms: 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