title: A Retrospective, Observational Study of Enteral Nutrition in Patients with Enteroatmospheric Fistulas.
abstract: Enteroatmospheric fistulas (EAFs) represent a challenging problem in patients with an open abdomen (OA). A retrospective, descriptive study was conducted to evaluate the effects of enteral alimentation on wound status and management and nutrition. All patients with an EAF in an OA treated between October 2012 and December 2014 at a university hospital in Germany were included without criteria for exclusions. Demographic and morbidity-related data collected included age, gender, surgeries, OA grading, body mass index (BMI), serum albumin, and serum creatinin. Underlying diseases and time between the index operation and the formation of the OA and EAFs were analyzed in relation to the initiation of enteral nutrition (EN), which can aggravate and contaminate the OA due to intestinal secretions necessary for digestion. The OA was described in size and area of the fascia defect and classified according to the Björck Scale. The number and location of the fistulas and the duration of negative pressure wound therapy (NPWT) were documented. Outcome parameters included fistula volume, wound management (eg, dressing change frequency, need for wound revision), feeding tolerance, systemic impact of nutrition, nutrition status at discharge, and mortality. Data were analyzed using primary descriptive statistics. The Mann-Whitney test was used to evaluate changes in fistula volume and BMI; categorical data were compared using Fisher's exact test. A P value less than 0.05 was considered significant. Ten (10) patients (8 women, median age of participants 55.4 [range 44-71] years) were treated during the study time period. Seven (7) patients had the first fistula orifice in the upper jejunum (UJF); 8 had more than 1 fistula. EN was initiated with high caloric liquid nutrition and gradually increased to a 25 kcal/kg/day liquid or solid nutrition. All patients were provided NPWT at 75 mm Hg to 100 mm Hg. EN was not followed by a significant increase of median daily fistula volume (1880 mL versus 2520 mL, P = 0.25) or the need for more frequent changes of NPWT dressings (days between changes 2.6 versus 2.9, P = 0.19). In 9 patients, the severity of wound complications such as inflammation or skin erosion decreased both in frequency and magnitude (eg, affected area). All patients achieved a sufficient oral intake, but only 3 were discharged from the hospital without parenteral nutrition. In this study, EN did not cause additional problems in wound management but did not provide sufficient alimentation in patients with a UJF. Prospective studies are needed to clarify associations between EN, nutrition, and wound management.
authors.affiliation: University Hospital and Clinics Frankfurt/Main, Department of General and Visceral Surgery, Frank- furt/Main, Hassia, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Reinisch
authors.affiliation: University Hospital and Clinics Frankfurt/Main, Department of General and Visceral Surgery, Frank- furt/Main, Hassia, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Liese
authors.affiliation: University Hospital and Clinics Frankfurt/Main, Department of General and Visceral Surgery, Frank- furt/Main, Hassia, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Woeste
authors.affiliation: University Hospital and Clinics Frankfurt/Main, Department of General and Visceral Surgery, Frank- furt/Main, Hassia, Germany.
authors.forename: Wolf
authors.initials: W
authors.lastname: Bechstein
authors.affiliation: University Hospital and Clinics Frankfurt/Main, Department of General and Visceral Surgery, Frank- furt/Main, Hassia, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Habbe
mesh_terms: D000005:Abdomen / Q000503:physiopathology; D000328:Adult; D000368:Aged; D004750:Enteral Nutrition / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000178:diet therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing