Bobkiewicz A, Walczak D, Smoliński S, Kasprzyk T, Studniarek A, Borejsza-Wysocki M, Ratajczak A, Marciniak R, Drews M, Banasiewicz T, et al.
International wound journal. Date of publication 2017 Feb 1;volume 14(1):255-264.
1. Int Wound J. 2017 Feb;14(1):255-264. doi: 10.1111/iwj.12597. Epub 2016 Mar 22.
Management of enteroatmospheric fistula with negative pressure wound therapy in
open abdomen treatment: a multicentre observational study.
Bobkiewicz A(1), Walczak D(2), Smoliński S(3), Kasprzyk T(4), Studniarek A(1),
Borejsza-Wysocki M(1), Ratajczak A(1), Marciniak R(1), Drews M(1), Banasiewicz
T(1).
Author information:
(1)Department of General, Endocrinological Surgery and Gastroenterological
Oncology, Poznan University of Medical Sciences, Poznan, Poland.
(2)Department of General Surgery, John Paul II Memorial Hospital, Belchatow,
Poland.
(3)Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan,
Poland.
(4)Department of General, Vascular and Oncologic Surgery, Regional Specialistic
Hospital, Słupsk, Poland.
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.
© 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.
DOI: 10.1111/iwj.12597
PMID: 27000995 [Indexed for MEDLINE]
