Prognostic Factors for Enteroatmospheric Fistula in Open Abdomen Treated with Negative Pressure Wound Therapy: a Multicentre Experience

J Gastrointest Surg. 2017 Aug;21(8):1328-1334. doi: 10.1007/s11605-017-3453-7. Epub 2017 May 23.

Abstract

Background: Reductions in mortality were reported with negative pressure wound therapy for laparostomy. However, some authors have voiced concern over an increased risk of enteroatmospheric fistulae. In this retrospective study, we hypothesized that surgical and metabolic derangements could increase the incidence of enteroatmospheric fistulae. We aimed to assess our experience and report long-term outcomes.

Methods: A multicentre review of all patients with a laparostomy managed with negative pressure wound therapy between 2005 and 2015 was undertaken. Features associated with enteroatmospheric fistulae were included in multivariate logistic regression.

Results: Fifty-seven patients were treated according to uniform protocol. Fourteen per cent (8/57) presented enteroatmospheric fistulae. Mesenteric ischaemia and preoperative arterial serum lactate >3.5 mmol/L were associated with a significantly increased risk of enteroatmospheric fistulae. Preoperative arterial serum lactate >3.5 mmol/L was an independent predictor of enteroatmospheric fistulae with an odds ratio of 12.41 (95% CI 1.54-99.99). All mesenteric ischaemia patients with anastomosis (5/15) presented enteroatmospheric fistulae. In-hospital mortality was 26.3% (15/57). One-year mortality was 33.3% (19/57). Incisional hernia rate was 5.2% (2/38) after 14.2 (2.4-56.3) months of follow-up.

Discussion: Mesenteric ischaemia increases the risk of enteroatmospheric fistulae. Anastomosis should only be created in revascularized patients. When mesenteric vascularization is not restored, diversion is advised.

Keywords: Enteroatmospheric fistula; Negative pressure wound therapy; Open abdomen.

Publication types

  • Multicenter Study

MeSH terms

  • Abdominal Wound Closure Techniques / adverse effects*
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Intestinal Fistula / diagnosis
  • Intestinal Fistula / epidemiology
  • Intestinal Fistula / etiology*
  • Logistic Models
  • Male
  • Middle Aged
  • Negative-Pressure Wound Therapy / adverse effects*
  • Outcome Assessment, Health Care
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology*
  • Prognosis
  • Retrospective Studies
  • Risk Factors