“Enteroatmospheric Fistulae”—Gastrointestinal Openings in the Open Abdomen: A Review and Recent Proposal of a Surgical Technique

Abstract

The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue. The mortality of enteroatmospheric fistulae was as high as 70% in past decades but is currently approximately 40% due to advanced modern intensive care and improved surgical techniques. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome. Many of the principles applied to classic enterocutaneous fistulae are used as well. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs.

Epidemiology and outcome of patients with postoperative abdominal fistula

“…However, some studies have shown that the prolonged use of TPN leads to worse prognosis, further reducing protein rate and increasing catabolism. Malnutrition can be both a cause and a result of this anatomical and metabolic instability [10][11][12] .…”

The Use Of Negative Pressure Wound Therapy (NPWT) In The Management Of Enteroatmospheric Fistula – Case Report And Literature Review

“…Unfortunately, the desired results are not always achieved (11,17,24). The case we present here as well as the discussed papers prove that a number of different techniques may be combined with NPWT, yielding appropriate management of laparostomy with fistula.…”

“…Control over the discharged intestinal matter improves the conditions for the open abdomen to heal and provides the opportunity to place skin grafts, rotation flaps, or use other reconstructive surgery techniques. Enteroatmospheric fistula is ultimately transformed into enterocutaneous fistula, and the latter may eventually be closed within a longer period of time (several to sometimes 10+ months) (11,24).…”

Surgery for post-operative entero-cutaneous fistulas: is bowel resection plus primary anastomosis without stoma a safe option to avoid early recurrence? Report on 20 cases by a single center and systematic review of the literature

“…Report on 20 cases by a single center and systematic review of the literature ("Where") (8) and an adequate period of recovery after the previous surgery represents the right time to takedown the ECF in order to avoid an early recurrence or to avoid a very difficult abdominal closure in an already damaged abdominal wall ("When"). On the contrary, the scientific community has not achieved an agreement on "What" ("How") to do during the ECF takedown in order to avoid an early recurrence in the perioperative period (9)(10)(11)(12)(13)(14) and there is no consensus if it should be performed during one procedure with bowel resection and primary anastomosis without stoma, or over a two-step staged operation with bowel resection and creation of a temporary stoma followed later by reconnection surgery. Moreover, there is still no consensus on the safe use of mesh for closing the abdomen (15,16).…”