Use of a vacuum-assisted closure system for the management of enteroatmospheric fistulae

Tavusbay, Cengiz; Genç, Hüdai; Cin, Necat; Kar, Haldun; Kamer, Erdinç; Atahan, Kemal; Hacıyanlı, Mehmet

doi:10.1007/s00595-014-1020-3

Cited by 30 publications

(28 citation statements)

References 20 publications

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“…• an enteroatmospheric fistula (EAF) is defined as a pathological communication between intestinal lumen and atmosphere and represents a rare postoperative complication or trauma, resulting in a high mortality rate • negative pressure wound therapy significantly influences the spontaneous EAF closure, especially those characterised by distal location and low output fistulas • negative pressure wound therapy creates favourable conditions for outflow of intestinal contents, enhances the granulation of the wound bed and decreases local inflammation • presence of protruding mucosa is a crucial factor impairing spontaneous fistula closure highly challenging and characterised by a high mortality rate reported between 20% and 44% (1,2). Current indications for open abdomen management include abdominal compartment syndrome, dehiscence of abdominal wall (usually because of secondary peritonitis or damage control surgery), abdominal trauma or necrotising fasciitis (3,4).…”

Section: Key Messagesmentioning

confidence: 99%

“…An enteroatmospheric fistula (EAF) is defined as a pathological opening in the intestinal lumen directly into the atmosphere, and it represents a rare postoperative complication following abdominal surgery or trauma. Although intensive progress in the field of both intensive care and surgical management have been observed in last few decades, the treatment of EAFs is still highly challenging and characterised by a high mortality rate reported between 20% and 44% . Current indications for open abdomen management include abdominal compartment syndrome, dehiscence of abdominal wall (usually because of secondary peritonitis or damage control surgery), abdominal trauma or necrotising fasciitis .…”

Section: Introductionmentioning

confidence: 99%

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Management of enteroatmospheric fistula with negative pressure wound therapy in open abdomen treatment: a multicentre observational study

Bobkiewicz

Walczak

Smoliński

et al. 2016

International Wound Journal

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The management of enteroatmospheric fistula (EAF) in open abdomen (OA) therapy is challenging and associated with a high mortality rate. The introduction of negative pressure wound therapy (NPWT) in open abdomen management significantly improved the healing process and increased spontaneous fistula closure. Retrospectively, we analysed 16 patients with a total of 31 enteroatmospheric fistulas in open abdomen management who were treated using NPWT in four referral centres between 2004 and 2014. EAFs were diagnosed based on clinical examination and confirmed with imaging studies and classified into low (<200 ml/day), moderate (200-500 ml/day) and high (>500 ml/day) output fistulas. The study group consisted of five women and 11 men with the mean age of 52·6 years [standard deviation (SD) 11·9]. Since open abdomen management was implemented, the mean number of re-surgeries was 3·7 (SD 2·2). There were 24 EAFs located in the small bowel, while four were located in the colon. In three patients, EAF occurred at the anastomotic site. Thirteen fistulas were classified as low output (41·9%), two as moderate (6·5%) and 16 as high output fistulas (51·6%). The overall closure rate was 61·3%, with a mean time of 46·7 days (SD 43·4). In the remaining patients in whom fistula closure was not achieved (n = 12), a protruding mucosa was present. Analysing the cycle of negative pressure therapy, we surprisingly found that the spontaneous closure rate was 70% (7 of 10 EAFs) using intermittent setting of negative pressure, whereas in the group of patients treated with continuous pressure, 57% of EAFs closed spontaneously (12 of 21 EAFs). The mean number of NPWT dressing was 9 (SD 3·3; range 4-16). In two patients, we observed new fistulas that appeared during NPWT. Three patients died during therapy as a result of multi-organ failure. NPWT is a safe and efficient method characterised by a high spontaneous closure rate. However, in patients with mucosal protrusion of the EAFs, spontaneous closure appears to be impossible to achieve.

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Section: Key Messagesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of enteroatmospheric fistula with negative pressure wound therapy in open abdomen treatment: a multicentre observational study

Bobkiewicz

Walczak

Smoliński

et al. 2016

International Wound Journal

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“…Three possible outcomes are described for EAF treatment: spontaneous closure, conditioning of the surrounding wound, and conversion into an ECF with delayed surgical fistula elimination or definite ECF without need for fistula elimination . Furthermore, in 38.5% of the cases, there was spontaneous fistula closure during treatment, with higher probability in low‐output fistulas . In 58.8% of the included fistulas, surgical closure after wound conditioning was attempted .…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of enteroatmospheric fistulas in combination with negative pressure wound therapy: Experience on 3 cases and literature review

Wirth

Renz

Andrade

et al. 2018

International Wound Journal

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Enteroatmospheric fistulas (EAF) are rare but challenging and morbid complications of abdominal surgery and require time- as well as resource-consuming management. Furthermore, they severely affect patients' quality of life. Several treatment modalities for EAF management are described in the literature. We describe 3 consecutive cases of EAF treatment by employing negative pressure wound therapy (NPWT) along with either a special silicone fistula adapter or a Silo-Vac-like system in another case to isolate the fistula from the remaining abdominal wound. Spontaneous fistula closure was achieved in 2 of the 3 cases, and surgical resection of the small bowel segment harbouring EAF opening was possible in a third case after wound conditioning. The rate of fistula closure was 100% (n = 3/3). Compartmentalisation of the contaminated area using NPWT accelerated healing of the open abdominal wound remarkably. In summary, we present a useful tool for the challenging management of EAF and review the literature on different treatment options of EAF available today.

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“…Occurrence of enterocutaneous fistula has been observed after NPWT in open abdominal wound. However, the evidence in support of the occurrence of this complication after NPWT is weak[49-51]. …”

Section: Discussionmentioning

confidence: 99%

Systematic review of the negative pressure wound therapy in kidney transplant recipients

Shrestha¹

2016

WJT

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AIMTo review negative pressure wound therapy (NPWT) as an important addition to the conventional methods of wound management.METHODSA systematic review, performed by searching the PubMed, EMBASE and Cochrane Library databases, showed 11 case reports comprising a total of 22 kidney transplantation (KT) patients (range, 1 to 9), who were treated with NPWT. Application of NPWT was associated with successful healing of wounds, leg ulcer, lymphocele and urine leak from ileal conduit.RESULTSNo complications related to NPWT were reported. However, there was paucity of robust data on the effectiveness of NPWT in KT recipients; therefore, prospective studies assessing its safety and efficacy of NPWT and randomised trials comparing the effectiveness of NPWT with alternative modalities of wound management in KT recipients is recommended.CONCLUSIONNegative pressure incision management system, NPWT with instillation and endoscopic vacuum-assisted closure system are in investigational stage.

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Use of a vacuum-assisted closure system for the management of enteroatmospheric fistulae

Abstract: A VAC system can be successfully used for wound management in the control of fistula effluent in patients with an EAF in an open abdomen until spontaneous fistula closure occurs or definitive fistula surgery can be performed.

Cited by 30 publications

References 20 publications

Management of enteroatmospheric fistula with negative pressure wound therapy in open abdomen treatment: a multicentre observational study

Management of enteroatmospheric fistula with negative pressure wound therapy in open abdomen treatment: a multicentre observational study

Successful treatment of enteroatmospheric fistulas in combination with negative pressure wound therapy: Experience on 3 cases and literature review

Systematic review of the negative pressure wound therapy in kidney transplant recipients

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