Technique Advances in Enteroatmospheric Fistula Isolation After Open Abdomen: A Review and Outlook

Abstract

Enteroatmospheric fistula (EAF) after open abdomen adds difficulties to the management and increases the morbidity and mortality of patients. As an effective measurement, reconstructing gastrointestinal tract integrity not only reduces digestive juice wasting and wound contamination, but also allows expedient restoration of enteral nutrition and intestinal homeostasis. In this review, we introduce several technologies for the temporary isolation of EAF, including negative pressure wound therapy, fistuloclysis, fistula patch, surgical covered stent, three-dimensional (3D) printing stent, and injection molding stent. The manufacture and implantation procedures of each technique with their pros and cons are described in detail. Moreover, the approach in combination with finger measurement, x-ray imaging, and computerized tomography is used to measure anatomic parameters of fistula and design appropriate 3D printer-recognizable stereolithography files for production of isolation devices. Given the active roles that engineers playing in the technology development, we call on the cooperation between clinicians and engineers and the organization of clinical trials on these techniques.

Failure to Rescue (FTR) and Pitfalls in the Management of Complex Enteric Fistulas (CEF): From Rescue Surgery to Rescue Strategy

“…Definitive surgery was performed only after a sound understanding of the fistula anatomy and planning of abdominal wall reconstruction and after the patients were free from sepsis (Figure 1) and had a good health status, as indicated by a median P-Possum Score of 20 (IQR [16][17][18][19][20][21][22][23]. Before the skin incision, all fistulas were cannulated with a Foley catheter to prevent enteric spillage in the surgical field and identify the bowel loop during the surgical procedure.…”

“…The Fistula Adapter™ technique is one of the most feasible solutions because of its easy application and limited damage to surrounding tissues. In addition, it allows the application of an ostomy bag over the device and can be used in conjunction with NPWT [22][23][24].…”

“…Four patients could not be rescued. Two studies on the management of CEF described lower FTR rates and their relationship with clinical factors [23,33]. Wainstein et al [23] reported a 6% mortality rate in a monocentric cohort of 62 patients.…”

“…Two studies on the management of CEF described lower FTR rates and their relationship with clinical factors [23,33]. Wainstein et al [23] reported a 6% mortality rate in a monocentric cohort of 62 patients. In their study, the factors related to death were preoperative hypoalbuminemia and more than two anastomoses.…”

4D-printed bilayer hydrogel with adjustable bending degree for enteroatmospheric fistula closure

“…To date, there have been various techniques to control enteric effluent, such as self-expanding metal stents [ 6 ], silica gel patches [ 7 ], percutaneous endoscopic gastrostomy tube [ 8 ], silicone fistula plug [ 9 ], baby bottle nipples [ 10 ], and three-dimensional (3D)-printed thermoplastic polyurethane (TPU) stents [ 11 ]. However, these techniques may cause mechanical damage to the intestinal mucosa [ 12 ] and have trouble fitting the changeable bending structure of the bowels.…”