title: Classification, prevention and management of entero-atmospheric fistula: a state-of-the-art review.
abstract: BACKGROUND
  Entero-atmospheric fistula (EAF) is an enteric fistula occurring in the setting of an open abdomen, thus creating a communication between the GI tract and the external atmosphere. Management and nursing of patients suffering EAF carries several challenges, and prevention of EAF should be the first and best treatment option.
  
  
  OBJECTIVE
  Here, we present a novel modified classification of EAF and review the current state of the art in its prevention and management including nutritional issues and feeding strategies. We also provide an overview on surgical management principles, highlighting several surgical techniques for dealing with EAF that have been reported in the literature throughout the years.
  
  
  CONCLUSIONS
  The treatment strategy for EAF should be multidisciplinary and multifaceted. Surgical treatment is most often multistep and should be tailored to the single patient, based on the type and characteristics of the EAF, following its correct identification and classification. The specific experience of surgeons and nursing staff in the management of EAF could be enhanced, applying distinct simulation-based ex vivo training models.
authors: Emergency Surgery and Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, AUSL, Bologna, Italy. salo75@inwind.it.
authors: Salomone
authors: S
authors: Di Saverio
authors: Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy.
authors: Antonio
authors: A
authors: Tarasconi
authors: Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland.
authors: Dominik A
authors: DA
authors: Walczak
authors: General and Emergency Surgery Department, Terni Hospital, University of Perugia, Perugia, Italy.
authors: Roberto
authors: R
authors: Cirocchi
authors: Emergency Surgery and Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, AUSL, Bologna, Italy.
authors: Matteo
authors: M
authors: Mandrioli
authors: Emergency Surgery and Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, AUSL, Bologna, Italy.
authors: Arianna
authors: A
authors: Birindelli
authors: Emergency Surgery and Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, AUSL, Bologna, Italy.
authors: Gregorio
authors: G
authors: Tugnoli
mesh_terms: D058107:Abdominal Wound Closure Techniques; D006801:Humans; D007412:Intestinal Fistula / Q000145:classification / Q000209:etiology / Q000517:prevention & control*; D007813:Laparotomy / Q000009:adverse effects; D054843:Negative-Pressure Wound Therapy; D011183:Postoperative Complications / Q000145:classification / Q000473:pathology / Q000517:prevention & control*
keywords: Abdominal sepsis; Acute care surgery; Critical care; EAF management algorithm; Entero-atmospheric fistula; Fistula prevention; Frozen abdomen; Negative pressure wound therapy (NPWT); Open abdomen complications; Review; Small-bowel fistula; Vacuum-assisted closure