Treatment of small-bowel fistulae in the open abdomen with topical negative-pressure therapy |
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Authors: | D'Hondt Mathieu Devriendt Dirk Van Rooy Frank Vansteenkiste Franky D'Hoore André Penninckx Freddy Miserez Marc |
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Institution: | aDepartment of Digestive Surgery, Groeninge Hospital, President Kennedylaan 4, 8500 Kortrijk, Belgium;bDepartment of Digestive Surgery, University Hospitals Leuven, 3000 Leuven, Belgium |
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Abstract: | BackgroundAn open abdomen (OA) can result from surgical management of trauma, severe peritonitis, abdominal compartment syndrome, and other abdominal emergencies. Enteroatmospheric fistulae (EAF) occur in 25% of patients with an OA and are associated with high mortality.MethodsWe report our experience with topical negative pressure (TNP) therapy in the management of EAF in an OA using the VAC (vacuum asisted closure) device (KCI Medical, San Antonio, TX). Nine patients with 17 EAF in an OA were treated with topical TNP therapy from January 2006 to January 2009. Surgery with enterectomy and abdominal closure was planned 6 to 10 weeks later.ResultsThree EAF closed spontaneously. The median time from the onset of fistulization to elective surgical management was 51 days. No additional fistulae occurred during VAC therapy. One patient with a short bowel died as a result of persistent leakage after surgery.ConclusionsAlthough previously considered a contraindication to TNP therapy, EAF can be managed successfully with TNP therapy. Surgical closure of EAFs is possible after several weeks. |
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Keywords: | Open abdomen Enteroatmospheric fistula Topical negative pressure therapy VAC therapy |
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