Prävention von Dünndarmfisteln beim Laparostoma: Lessons learned

Abstract

We implemented a regimen, which is suitable for our mission in Afghanistan, as well as for medical evacuation and for the treatment of patients in our hospitals in Germany. It ensures a standardised treatment of the open abdominal cavity with an ideal protecting treatment of the bowel surface. Our algorithm utilises the advantages of the laparostoma while minimising the complications. The development of a small bowel fistula was eliminated in the evaluated patient group and mortality was clearly reduced.

Retrospective analysis of a VACM (vacuum-assisted closure and mesh-mediated fascial traction) treatment manual for temporary abdominal wall closure – results of 58 consecutive patients

“…The EAF rate of 6.5% during VACM therapy corresponds to the data described in the literature, although individual authors published fistula rates of 0% for patients who underwent VACM therapy [ 16 ].…”

“…The FCR reported after VACM therapy was 61.25% and thus higher than in studies where VAC therapy was applied alone (33%) [ 23 ], but it was lower than in other studies which reported FCRs of 76% [ 22 ], 78% [ 7 ] and 87% for patients who underwent VACM therapy [ 16 ]. In the publication by Willms et al [ 16 ], the average age of the patients was 53 years compared to an average age of 68.5 years of our own patient group.…”

“…The treatment manual used was already described in a similar form in other publications, and even higher FCRs were reported in some of these studies [ 16 ], [ 25 ].…”

“…As a result, the major objectives in the treatment of patients with OA are as follows: achieving fascial closure in the course of treatment and avoiding the occurrence of EAF [ 14 ]. Various studies showed that VACM therapy was associated with higher FCRs and lower incidence of EAF during treatment than VAC therapy alone [ 15 ], [ 16 ], [ 17 ]. In this retrospective study, the FCR, the mortality rate and the incidence of enteroatmospheric fistulas among patients of our department who were treated using a combined VAC/VACM treatment manual were to be retrospectively analysed.…”

Das abdominelle Kompartmentsyndrom

“…Soweit möglich, sollten folgende Maßnahmen durchgeführt werden: ▪ Deckung der Darmschlingen mit Omentum [20], ▪ Verwendung einer Viszeralschutzfolie [17,19] ▪ und schließlich so früh wie möglich der Faszienverschluss [6,20].…”