title: Management of enteroatmospheric fistula with negative pressure wound therapy in open abdomen treatment: a multicentre observational study.
abstract: 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.
authors.affiliation: Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Bobkiewicz
authors.affiliation: Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland.
authors.forename: Dominik
authors.identifier: http://orcid.org/0000-0001-9009-5039
authors.initials: D
authors.lastname: Walczak
authors.affiliation: Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Szymon
authors.initials: S
authors.lastname: Smoliński
authors.affiliation: Department of General, Vascular and Oncologic Surgery, Regional Specialistic Hospital, Słupsk, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kasprzyk
authors.affiliation: Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Studniarek
authors.affiliation: Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Borejsza-Wysocki
authors.affiliation: Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Ratajczak
authors.affiliation: Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Ryszard
authors.initials: R
authors.lastname: Marciniak
authors.affiliation: Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Drews
authors.affiliation: Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Banasiewicz
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult
keywords: Enteroatmospheric fistula; Laparostomy; Negative pressure wound therapy; Open abdomen