The management of enteroatmospheric fistula (EAF) in open abdomen (OA) therapy is challenging and associated with high mortality rate. The introduction of negative pressure wound therapy (NPWT) in OA management significantly improved the healing processes and increased spontaneous fistula closure rate.
Methods
Retrospectively, we analyzed sixteen patients with a total of 31 EAF in OA management using NPWT in four referral centers in Poland between 2004 and 2014. EAFs were diagnosed based on clinical examination and confirmed with imaging studies and classified into low (< 200ml/day), moderate (200-500ml/day) and high (>500 ml/day) output fistulas.
Results
The study group consisted of 5 women and 11 men with the mean age of 52.6±11.9 years. Since open abdomen management was implemented, the mean number of re-surgeries was 3.7±2.2). There were 24 of EAFs located in the small bowel, whereas 4 were located in the colon. In three patients EAF occurred at the anastomotic site. 13 fistulas were classified as low output (41.9%), two as moderate (6.5%) and sixteen as high output fistulas (51,6%). An overall closure rate was 61,3% with the mean time of 46.7±43.4) days. In all remaining patients in whom fistula closure was not achieved (n=12), a protruding mucosa was present. Analyzing the cycle of negative pressure therapy, surprisingly we found that spontaneous closure rate was 70% (7/10 EAFs) using intermittent setting of negative pressure whereas in group of patients treated with continuous pressure 57% of EAFs closed spontaneously (12/21 EAFs). The mean number of NPWT dressing was 9±3.3 (range 4-16). In two patients, we observed new fistulas which appeared during NPWT. Three patients died during therapy as a result of multi-organ failure.
Conclusion
NPWT is a safe and efficient method for OA management with concomitant EAF. Although, closure of EAF is challenging, we found NPWT as a useful technique for spontaneous EAF closure. Based on our experience, low output fistulas as well as no mucosal protrusion positively influence on higher EAF spontaneous closure rate in OA using NPWT.
Clinical relevance
Because of lack of firm conclusions and recommendations, it is highly important to collect data and outcomes to create guidelines and consensus regarding NPWT in open abdomen management complicated with EAFs.
Conflict of Interest
The authors declare that they have no conflict of interest.
