The stool shield: a novel approach to the colo-atmospheric fistula

Use of a vacuum-assisted closure system for the management of enteroatmospheric fistulae

PURPOSE

The aim of this study was to analyze the management of enteroatmospheric fistulae (EAF) in an open abdomen using vacuum-assisted closure (VAC) therapy.

METHODS

Eighteen patients (ten male/eight female) were treated in our surgical department for the management of EAF. VAC therapy was used to manage both complex and open abdominal wounds and for effluent control in all patients except one until definitive surgery could be performed or spontaneous closure of the EAF occurred.

RESULTS

The median age of the patients was 61.1 years (range 29-84 years). Their average hospital stay was 88.89 days (range 22-129 days). The median number of VAC applications was 22.5, and the median duration of VAC applications was 43.6 days (range 14-114 days). Non-surgical spontaneous closure of the fistulae with negative pressure wound therapy could be achieved in four patients. In the other six patients, after the EAF were controlled with VAC therapy, definitive surgery was performed. Primary fascial repair was performed in two patients, and the component separation technique was synchronously performed in another two patients. Ventral hernia repair using polypropylene mesh was performed in a patient 1 year after discharge from the hospital. One patient was discharged with skin grafting plus ileostomy after the EAF was managed with VAC therapy. Eight patients (44.4%) died due to intraabdominal infections and sepsis, which could not be controlled despite all precautions. No VAC-related complications were observed in this study.

CONCLUSION

A VAC system can be successfully used for wound management in the control of fistula effluent in patients with an EAF in an open abdomen until spontaneous fistula closure occurs or definitive fistula surgery can be performed.