The review summarises the handling of open abdomen with fistula, which is one of the most serious complications in connection with abdominal surgery. Most often, morbidity and mortality are caused by lack of fistula control and multi-organ dysfunction. The primary aim is to prevent sepsis, control the fistula and optimise the patient's physiology. Vacuum-assisted closure treatment combined with a creative approach is recommended and increases the possibility of closure of the abdominal wall. Plastic surgical assistance is usually required. As the frequency of the condition is low, and as it is difficult to handle, treatment should be performed in specialised centres.