Entero-atmospheric fistula migration: a new management alternative for complex septic open abdomen

Anaesthesiology Intensive Therapy · 4 authors, 7 centres

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TL;DR

This narrative review describes two new surgical alternatives for managing entero-atmospheric fistulas in complex septic open abdomens.

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This narrative review discusses the management of open abdomens and the challenge of entero-atmospheric fistulas (EAF). It outlines the history and goals of temporary abdominal closure (TAC), highlighting the benefits of negative pressure wound therapy (NPWT) for achieving fascial closure. The authors describe two new alternatives for managing EAF: using an intra-abdominal 'donut' to exclude the fistula site under NPWT, and diverting effluents via a fecal incontinence control device through a stoma. A treatment algorithm is proposed for migrating a fistula from the midline to a lateral position to facilitate abdominal closure.

STUDY TYPE

narrative_review

SPECIALTY

surgery

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100% · A

ORIGINAL PAPER

PMC10173142

Entero-atmospheric fistula migration: a new management alternative for complex septic open abdomen

Anaesthesiology Intensive Therapy

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ABSTRACT

The open abdomen technique is a surgical strategy used in life-threatening conditions. After recognizing the morbidity and mortality attributed to abdominal compartment syndrome (ACS), several methods were developed to avoid this complication. The primary goal of temporary abdominal closure (TAC) is to create a tension-free closure of the abdomen without increasing intra-abdominal pressure. The optimal method of TAC should contain and protect the contents of the peritoneal cavity from external contamination and injury, preserve fascia; minimize desiccation and damage to viscera, remove and quantify third space fluid; prevent loss of domain, lower bacterial count, inflammatory response, keep the patient’s abdominal wall skin dry and intact; preserve the integrity of the abdominal wall, be simple to perform and maintain, provide ease of reentry and have minimal adverse physiologic effects. Negative pressure wound therapy allowed the TAC method to achieve these objectives, but the presence of enteric fistulas or entero-atmospheric fistulas is still a challenge for even the most experienced surgeon. Here we describe two new alternatives to manage the septic complex abdomen with entero-atmospheric fistula.

CITATION EXPORT

Bruno M. Pereira, Juan C. Duchesne, Admar Concon-Filho et al.. Entero-atmospheric fistula migration: a new management alternative for complex septic open abdomen. Anaesthesiology Intensive Therapy. (2020). https://doi.org/10.5114/ait.2020.92748

AUTHORS

4 · 7 CENTRES

Bruno M. Pereira, Juan C. Duchesne, Admar Concon-Filho, Ari Leppãniemi

1World Society of the Abdominal Compartment (WSACS)
2Masters Program in Health Applied Sciences, Vassouras University, Vassouras, RJ, Brazil
3CEO Grupo Surgical, Brazil
4Hospital e Maternidade Galileo, Valinhos, Brazil
5Department of Surgery, Tulane University School of Medicine, Norman McSwain Level I Trauma Center, University Medical Center, New Orleans, Louisiana, USA
6Bariatric Surgery Group – GCBV, Valinhos, Brazil
7Department of Surgery, Meilahti Hospital, University of Helsinki, Finland