Systematic and Specific Treatment of Patients with Enteroatmospheric Fistulas: From Initial Conservative Treatment to Definitive Surgery.
BACKGROUND
The open abdomen is a widespread therapeutic resource; however, it is also a source of complications, of which the enteroatmospheric fistulas (EAFs) pose one of the greatest problems. The objective of this study was to describe the implemented strategy for handling enteroatmospheric fistulas, and secondarily, to analyze the differential results based on a change in the conservative local treatment specifically designed for the stated complication.


METHODS
From March 2002 to March 2014, patients treated for EAF were retrospectively analyzed. They were divided into 2 groups: Group 1 (G1: 2002 - 2007), treated with an occlusive vacuum device (SIVACO), similar to that used for other enterocutaneous fistulas, and Group 2 (G2: 2008 - 2014), covered in a specific modality for EAF. Results of conservative and surgical treatment were described and then the two groups were statistically compared.


RESULTS
Study participants comprised 62 patients. Twelve cases (19.4%) healed with conservative treatment. This was statistically related with a baseline albumin level >3 g/dL, single lesions with no visible mucosa and baseline output <700 mL/d. In G1, the output fall was higher, while G2 required fewer wound dressing changes and enteral nutrition was feasible in a significantly higher number of patients. Forty-seven patients underwent reconstructive surgery. The mortality-associated variables were preoperative hypoalbuminemia and 2 or more anastomoses. Overall mortality was 8% (5 patients). In the multivariate model, only initial output (<700 mL/d) was an independent predictor for spontaneous closure, whereas 2 or more anastomoses and hypoalbuminemia were negative independent predictors.


CONCLUSIONS
Systematic management of enteroatmospheric fistulas, following a rigorous protocol and a two-step specific treatment, resulted in a practical approach and yielded good results in healing and mortality.
Division of Surgery, Pirovano Hospital, Buenos Aires, Argentina.
Daniel E
DE
Wainstein
Division of Surgery, Pirovano Hospital, Buenos Aires, Argentina.
Pablo
P
Sisco
Service of Nutrition, Pirovano Hospital, Buenos Aires, Argentina.
María L
ML
Deforel
Department of Surgery, British Hospital, Buenos Aires, Argentina.
Mariano
M
Irigoyen
Division of Surgery, Pirovano Hospital, Buenos Aires, Argentina.
Jorge
J
Devoto
Division of Surgery, Pirovano Hospital, Buenos Aires, Argentina.
Juan M
JM
Zarate
D058107:Abdominal Wound Closure Techniques / Q000401:mortality* / Q000706:statistics & numerical data; D001118:Argentina / Q000453:epidemiology; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D000072700:Conservative Treatment / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000401:mortality* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome