Enteroatmospheric fistulae in open abdomen: Management and outcome - Single center experience

Background: An enteroatmospheric fistula (EAF) is a known, morbid complication of open abdomen (OA) treatment. Patients with EAF often require repeated operations and long-lasting hospitalization. The goal is to reach prompt closure of both the fistula and the OA to avoid further morbidity and mortality. This study describes and analyzes the treatment of EAFs in our clinic and aims at clarifying the factors contributing to the outcome. Materials and Methods: This study was carried out as a single-institution retrospective chart analysis of patients treated with an OA and EAF at our institute between years 2004 and 2014. Twenty-six patients were included in the analysis. Results: Twenty-three (88%) of the EAFs were primarily managed surgically: 14 with suturing and 9 with resection and/or stoma. From the latter group two died 1 and 2 days, respectively, after surgery. Of the remaining 21 patients, EAF recurred in 12/14 (86%) patients after suturing whereas in only 3/7 (43%) patients after resection and/or stoma (p = 0.04). Among the 21 early survivors after EAF repair, four patients reached fascial closure simultaneously with the EAF repair. Of the rest 9/17 had Bogota bag or drapes as temporary abdominal closure and 8/17were treated with vacuum assisted closure device with or without fascial traction by mesh. All the nine patients treated with non-negative pressure dressings developed recurrence but only 4/8 in the negative-pressure treated group (p < 0.02). All conservatively treated patients developed persistent EAF. The overall in-hospital mortality rate was 35% (9/26). Conclusion: Surgical repair of EAF has a high failure rate. Primary resection of the affected region appears to be the most successful approach to avoid EAF recurrence. Furthermore, negative pressure wound therapy is superior to non-negative-pressure solutions in relation to EAF recurrence. (c) 2016 The Authors. Published by Elsevier Ltd on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).