title: Successful bridging treatment and healing of enteric fistulae by vacuum-assisted closure (VAC) therapy and targeted drainage in patients with open abdomen.
abstract: OBJECTIVE
  The object of this study was to investigate the bridging treatment of enteric fistulae by vacuum-assisted closure (VAC) therapy in patients with open abdomen.
  
  
  METHODS
  We retrospectively analyzed patients who have been treated between 1 January 2007 and 31 December 2008 at the intensive care unit of the Department of General Surgery, Medical University Vienna. Control of the fistula was established by VAC therapy to bridge the patients to the time of the fistula resection.
  
  
  RESULTS
  In the period of investigation, we treated nine (six men/three women) patients suffering from enteric fistulae with VAC therapy. The median age of the patients was 48 (range, 37-67) years. The median duration of VAC therapy was 76 (range, 53-128) days. The median length of stay in the intensive care unit was 44 (range, 25-127) days. The median APACHE II score was 23 (range, 18-25). The predicted mortality was 40%; the actual mortality was 11% (one patient). Primary fascial closure was achieved after median 91 (range, 89-92) days in three patients (33%) and secondary fascial closure after median 292 (range, 252-546) days in another three patients (33%). Fistulae were cured with VAC (five patients, 56%) and surgical resection (three patients, 33%). None of the patients developed a refistulation at the time of follow-up.
  
  
  CONCLUSIONS
  Control of enteric fistulae by VAC therapy can lead to spontaneous fistula closure and is associated with a low mortality.
authors.affiliation: Department of General Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. stefan.stremitzer@meduniwien.ac.at
authors.forename: Stefan
authors.initials: S
authors.lastname: Stremitzer
authors.forename: Andrea
authors.initials: A
authors.lastname: Dal Borgo
authors.forename: Thomas
authors.initials: T
authors.lastname: Wild
authors.forename: Peter
authors.initials: P
authors.lastname: Goetzinger
mesh_terms: D000005:Abdomen / Q000473:pathology*; D000328:Adult; D000368:Aged; D016154:Digestive System Fistula / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005205:Fascia / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D010538:Peritonitis / Q000209:etiology; D014945:Wound Healing