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Shigeta K, Kim S, Nakae R, Igarashi Y, Sakamoto T, Ogasawara T, Masuno T, Arai M, Yokobori S. Effectiveness of vacuum-assisted wound closure and mesh-mediated fascial traction in open abdomen management. Surg Today 2024:10.1007/s00595-024-02899-7. [PMID: 39043902 DOI: 10.1007/s00595-024-02899-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE To determine the effectiveness of vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in patients undergoing open abdomen management (OAM). METHODS Data from cases with OAM for at least five days who were admitted to our institution between January 2011 and December 2020 were included. We compared the patient's age, sex, medical history, indication for initial surgery, APACHE II scores, indication for OAM, operative time, intraoperative blood loss, intraoperative transfusion, success of primary fascial closure (rectus fascial closure and bilateral anterior rectus abdominis sheath turnover flap method), success of planned ventral hernia, duration of OAM, and in-hospital mortality between patients undergoing VAWCM (VAWCM cases, n = 27) and vacuum-assisted wound closure (VAWC) alone (VAWC cases, n = 25). RESULTS VAWCM cases had a significantly higher success rate of primary fascial closure (70% vs. 36%, p = 0.030) and lower in-hospital mortality (26% vs. 72%, p = 0.002) than VAWC cases. A multivariate logistic regression analysis showed that VAWCM was an independent factor influencing in-hospital mortality (odds ratio, 0.14; 95% confidence interval: 0.04-0.53; p = 0.004). CONCLUSION VAWCM is associated with an increased rate of successful primary fascial closure and may reduce in-hospital mortality.
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Affiliation(s)
- Kenta Shigeta
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Shiei Kim
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Taigo Sakamoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Tomoko Ogasawara
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Masatoku Arai
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Bobkiewicz A, Francuzik W, Martinkosky A, Borejsza-Wysocki M, Ledwosinski W, Szmyt K, Banasiewicz T, Krokowicz L. Negative Pressure Level and Effects on Bacterial Growth Kinetics in an in vitro Wound Model. Pol J Microbiol 2024; 73:199-206. [PMID: 38905277 PMCID: PMC11192228 DOI: 10.33073/pjm-2024-018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/20/2024] [Indexed: 06/23/2024] Open
Abstract
Negative Pressure Wound Therapy (NPWT) has been widely adopted in wound healing strategies due to its multimodal mechanism of action. While NPWT's positive impression on wound healing is well-established, its effect on bacterial load reduction remains equivocal. This study investigates NPWT's efficacy in reducing bioburden using an in vitro porcine skin model, focusing on the impact of Staphylococcus aureus and Staphylococcus epidermidis. Custom-made negative pressure chambers were employed to apply varying negative pressures. Porcine skin was cut into 5 × 5 cm squares and three standardized wounds of 6 mm each were created using a biopsy punch. Then, wounds were infected with S. aureus and S. epidermidis bacterial suspensions diluted 1:10,000 to obtain a final concentration of 1.5 × 104 CFU/ml and were placed in negative pressure chambers. After incubation, bacterial counts were expressed as colony-forming units (CFU) per ml. For S. aureus at 120 hours, the median CFU, mean area per colony, and total growth area were notably lower at -80 mmHg when compared to -250 mmHg and -50 mmHg, suggesting an optimal negative pressure for the pressure-dependent inhibition of the bacterial proliferation. While analyzing S. epidermidis at 120 hours, the response to the negative pressure was similar but less clear, with the minor CFU at -100 mmHg. The influence of intermittent negative pressure on the S. epidermidis growth showed notably lower median CFU with the interval therapy every hour compared to the S. aureus control group. This study contributes valuable insights into NPWT's influence on the bacterial load, emphasizing the need for further research to reformulate its role in managing contaminated wounds.
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Affiliation(s)
- Adam Bobkiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
| | - Wojciech Francuzik
- Department of Dermatology, Venerology and Allergology. Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Amy Martinkosky
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
| | - Maciej Borejsza-Wysocki
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
| | - Witold Ledwosinski
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
| | - Krzysztof Szmyt
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
| | - Lukasz Krokowicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
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Pepe G, Chiarello MM, Bianchi V, Fico V, Altieri G, Tedesco S, Tropeano G, Molica P, Di Grezia M, Brisinda G. Entero-Cutaneous and Entero-Atmospheric Fistulas: Insights into Management Using Negative Pressure Wound Therapy. J Clin Med 2024; 13:1279. [PMID: 38592102 PMCID: PMC10932196 DOI: 10.3390/jcm13051279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Enteric fistulas are a common problem in gastrointestinal tract surgery and remain associated with significant mortality rates, due to complications such as sepsis, malnutrition, and electrolyte imbalance. The increasingly widespread use of open abdomen techniques for the initial treatment of abdominal sepsis and trauma has led to the observation of so-called entero-atmospheric fistulas. Because of their clinical complexity, the proper management of enteric fistula requires a multidisciplinary team. The main goal of the treatment is the closure of enteric fistula, but also mortality reduction and improvement of patients' quality of life are fundamental. Successful management of patients with enteric fistula requires the establishment of controlled drainage, management of sepsis, prevention of fluid and electrolyte depletion, protection of the skin, and provision of adequate nutrition. Many of these fistulas will heal spontaneously within 4 to 6 weeks of conservative management. If closure is not accomplished after this time point, surgery is indicated. Despite advances in perioperative care and nutritional support, the mortality remains in the range of 15 to 30%. In more recent years, the use of negative pressure wound therapy for the resolution of enteric fistulas improved the outcomes, so patients can be successfully treated with a non-operative approach. In this review, our intent is to highlight the most important aspects of negative pressure wound therapy in the treatment of patients with enterocutaneous or entero-atmospheric fistulas.
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Affiliation(s)
- Gilda Pepe
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (G.P.); (V.B.); (V.F.); (G.A.); (S.T.); (G.T.); (P.M.); (M.D.G.)
| | - Maria Michela Chiarello
- General Surgery Operative Unit, Department of Surgery, Provincial Health Authority, 87100 Cosenza, Italy;
| | - Valentina Bianchi
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (G.P.); (V.B.); (V.F.); (G.A.); (S.T.); (G.T.); (P.M.); (M.D.G.)
| | - Valeria Fico
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (G.P.); (V.B.); (V.F.); (G.A.); (S.T.); (G.T.); (P.M.); (M.D.G.)
| | - Gaia Altieri
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (G.P.); (V.B.); (V.F.); (G.A.); (S.T.); (G.T.); (P.M.); (M.D.G.)
| | - Silvia Tedesco
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (G.P.); (V.B.); (V.F.); (G.A.); (S.T.); (G.T.); (P.M.); (M.D.G.)
| | - Giuseppe Tropeano
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (G.P.); (V.B.); (V.F.); (G.A.); (S.T.); (G.T.); (P.M.); (M.D.G.)
| | - Perla Molica
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (G.P.); (V.B.); (V.F.); (G.A.); (S.T.); (G.T.); (P.M.); (M.D.G.)
| | - Marta Di Grezia
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (G.P.); (V.B.); (V.F.); (G.A.); (S.T.); (G.T.); (P.M.); (M.D.G.)
| | - Giuseppe Brisinda
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (G.P.); (V.B.); (V.F.); (G.A.); (S.T.); (G.T.); (P.M.); (M.D.G.)
- Department of Medicine and Surgery, Catholic School of Medicine “Agostino Gemelli”, Largo Francesco Vito 1, 00168 Rome, Italy
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Denicu MM, Preda SD, Râmboiu S, Bratiloveanu T, Nemes R, Chiutu L. The Crucial Role of Nurses in the Comprehensive Management of Postoperative Enteroatmospheric Fistula: A Narrative Review. CURRENT HEALTH SCIENCES JOURNAL 2024; 50:12-19. [PMID: 38854421 PMCID: PMC11157346 DOI: 10.12865/chsj.50.01.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/21/2024] [Indexed: 06/11/2024]
Abstract
Postoperative enteroatmospheric fistula (EAF) presents a complex challenge in surgical care, with multifactorial causes and significant implications for patient outcomes and quality of life. This narrative review explores the essential role of nurses in the comprehensive management of EAF, encompassing preoperative, intraoperative, and postoperative care. It emphasizes the importance of wound care management, nutritional support, psychosocial assistance, patient education, collaboration, continuous professional development, and research engagement in optimizing patient outcomes. By addressing these facets, healthcare providers can enhance their understanding and management of EAF, ultimately improving patient care in this intricate surgical complication.
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Affiliation(s)
- Maria Mădălina Denicu
- University of Medicine and Pharmacy of Craiova
- ICU Clinic, Craiova Emergency Clinical Hospital
| | - Silviu Daniel Preda
- University of Medicine and Pharmacy of Craiova
- First Clinic of Surgery, Craiova Emergency Clinical Hospital
| | - Sandu Râmboiu
- University of Medicine and Pharmacy of Craiova
- First Clinic of Surgery, Craiova Emergency Clinical Hospital
| | - Tudor Bratiloveanu
- University of Medicine and Pharmacy of Craiova
- First Clinic of Surgery, Craiova Emergency Clinical Hospital
| | | | - Luminita Chiutu
- University of Medicine and Pharmacy of Craiova
- ICU Clinic, Craiova Emergency Clinical Hospital
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Calero Castro FJ, Padillo Eguía A, Durán Muñoz‐Cruzado V, Tallón Aguilar L, Tinoco González J, Laga I, de la Portilla de Juan F, Pareja Ciuró F, Padillo Ruiz J. Personalized additive manufacturing of devices for the management of enteroatmospheric fistulas. Bioeng Transl Med 2023; 8:e10583. [PMID: 38023715 PMCID: PMC10658531 DOI: 10.1002/btm2.10583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 12/01/2023] Open
Abstract
Additive manufacturing techniques allow the customized design of medical devices according to the patient's requirements. Enteroatmospheric fistula is a pathology that benefits from this personalization due to its extensive clinical variability since the size and morphology of the wound differ extensively among patients. Standard prosthetics do not achieve proper isolation of the wound, leading to a higher risk of infections. Currently, no effective personalized technique to isolate it has been described. In this work, we present the workflow for the design and manufacture of customized devices adapted to the fistula characteristics as it evolves and changes during the treatment with Negative Pressure Wound Therapy (NPWT). For each case, a device was designed with dimensions and morphology depending on each patient's requirements using white light scanning, CAD design, and additive manufacturing. The design and manufacture of the devices were performed in 230.50 min (184.00-304.75). After the placement of the device, the wound was successfully isolated from the intestinal content for 48-72 h. The therapy was applied for 27.71 ± 13.74 days, and the device was redesigned to adapt to the wound when geometrical evolutionary changes occur during the therapy. It was observed a decrease in weekly cures from 23.63 ± 10.54 to 2.69 ± 0.65 (p = 0.001). The fistulose size was reduced longitudinal and transversally by 3.25 ± 2.56 cm and 6.06 ± 3.14 cm, respectively. The wound depth also decreased by 1.94 ± 1.08 cm. In conclusion, customization through additive manufacturing is feasible and offers promising results in the generation of personalized devices for the treatment of enteroatmospheric fistula.
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Affiliation(s)
- Francisco José Calero Castro
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
| | | | - Virginia Durán Muñoz‐Cruzado
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
- University of SevilleSevilleSpain
| | - Luis Tallón Aguilar
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
- University of SevilleSevilleSpain
| | - José Tinoco González
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
- University of SevilleSevilleSpain
| | - Imán Laga
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
| | - Fernando de la Portilla de Juan
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
- University of SevilleSevilleSpain
| | - Felipe Pareja Ciuró
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
- University of SevilleSevilleSpain
| | - Javier Padillo Ruiz
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
- University of SevilleSevilleSpain
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Hu Q, Cui J, Zhang H, Liu S, Ramalingam M. A 5 + 1-Axis 3D Printing Platform for Producing Customized Intestinal Fistula Stents. 3D PRINTING AND ADDITIVE MANUFACTURING 2023; 10:955-970. [PMID: 37886400 PMCID: PMC10599436 DOI: 10.1089/3dp.2021.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Tailored intestinal fistula stents with a hollow bent pipe structure prepared by using a three-axis bio-printing platform are often unsuitable due to low printing efficiency and quality caused by the unavoidable need for a supporting structure. Herein, a 5 + 1-axis 3D printing platform was built and developed for producing support-free intestinal fistula stents. A 3D model of the target stent shape and dimensions was treated by a dynamic slicing algorithm, which was then used to prepare a motion control code. Our printing method showed improved printing efficiency, superior stent surface properties and structure and ideal elasticity and mechanical strength to meet the mechanical requirements of the human body. Static simulations showed the importance of axial printing techniques, whereas the stent itself was shown to have excellent biocompatibility with wettability and cell proliferation tests. We present a customizable, efficient, and high-quality method with the potential for preparing bespoke stents for treating intestinal fistulas.
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Affiliation(s)
- Qingxi Hu
- Rapid Manufacturing Engineering Center, School of Mechatronical Engineering and Automation, Shanghai University, Shanghai, China
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai University, Shanghai, China
- National Demonstration Center for Experimental Engineering Training Education, Shanghai University, Shanghai, China
| | - Jian Cui
- Rapid Manufacturing Engineering Center, School of Mechatronical Engineering and Automation, Shanghai University, Shanghai, China
| | - Haiguang Zhang
- Rapid Manufacturing Engineering Center, School of Mechatronical Engineering and Automation, Shanghai University, Shanghai, China
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai University, Shanghai, China
- National Demonstration Center for Experimental Engineering Training Education, Shanghai University, Shanghai, China
| | - Suihong Liu
- Rapid Manufacturing Engineering Center, School of Mechatronical Engineering and Automation, Shanghai University, Shanghai, China
| | - Murugan Ramalingam
- Biomaterials and Organ Engineering Group, Centre for Biomaterials, Cellular and Molecular Theranostics, School of Mechanical Engineering, Vellore Institute of Technology, Vellore, India
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7
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Ratajczak A, Ratajczak-Lange M, Zastawna K, Saad Abdalla Al-Zawi A, Banasiewicz T. Dynamic Kinesiotherapy: A Novel Technique That Promotes Appropriate Abdominal Wound Healing. Cureus 2023; 15:e41121. [PMID: 37519625 PMCID: PMC10382789 DOI: 10.7759/cureus.41121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Appropriate wound healing is a crucial phase of surgical patients' management, as it facilitates early mobilization and return to everyday life. Also, it is required before offering patients the next phase of treatment. Surgical wound closure techniques have evolved remarkably; they include simple sutures, surgical clips, and adhesive compounds. Some appliances are used to support the closed surgical wounds and assist the abdominal wall muscles' movements; however, they may make breathing uncomfortable or cause pain. Here, we introduce a novel, effective technique that facilitates appropriate surgical wound healing. Dynamic kinesiotherapy is an easy procedure to perform, handy, beneficial, safe, and cost-effective.
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Affiliation(s)
- Andrzej Ratajczak
- General and Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznań, POL
| | - Małgorzata Ratajczak-Lange
- General and Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznań, POL
| | - Kinga Zastawna
- General and Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznań, POL
| | - Abdalla Saad Abdalla Al-Zawi
- General and Breast Surgery, Mid and South Essex University Hospital Group, Basildon, GBR
- General and Breast Surgery, Basildon and Thurrock University Hospital, Basildon, GBR
- General and Breast Surgery, Anglia Ruskin University, Chelmsford, GBR
| | - Tomasz Banasiewicz
- General and Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznań, POL
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8
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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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9
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Management of enteroatmospheric fistula: A ten-year experience following fifteen years of learning. Surgery 2023; 173:1079-1085. [PMID: 36653234 DOI: 10.1016/j.surg.2022.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/20/2022] [Accepted: 12/11/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Enteroatmospheric fistulas are a serious complication of Open Abdomen. The goal of this study was to present the strategy and results of enteroatmospheric fistulas treatment during the last 10 years, after a long learning period. METHODS Seventy-seven patients with enteroatmospheric fistulas were treated and the data recorded between 2012 and 2021. For local treatment, 3 negative pressure methods were used, according to the wound characteristics. The results of conservative and surgical treatments were retrospectively identified and described, including nutritional recovery, morbidity and mortality. Predictors of spontaneous closure, as well as risk factors for the fistula's recurrence and mortality were analyzed. RESULTS Nutritional and clinical recovery was achieved in 66 patients (85.7%). Fourteen patients (18%) were healed without surgery after a median of 57 days (range 35-426 days). Unique lesions (13/46; P = .02, OR 10.23), initial output ≤700 mL/day (9/28; P = .0035, OR 3.79) and deep fistulas (9/12; P = .00001, OR 33.6) were encountered and acknowledged to be as spontaneous closure factors. Fifty-six patients (72.7%) required reconstructive surgery of the intestinal tract after a median of 187 days since last laparotomy (range: 63-455 days). There were 9 postoperative recurrences (16%), 5 of them closed with conservative treatment. No significant risk factors for recurrence nor postoperative mortality were found. Fistula complete closure was achieved in 63 of the 77 patients studied (81.8%), and 7 patients died (9%). CONCLUSION The combination of 3 vacuum methods used for enteroatmospheric fistula management was effective. Spontaneous closure of an enteroatmospheric fistula is unlikely but feasible when lesions are single, deep, with limited output, and when intestinal continuity is preserved. Surgical indications are well defined, although mortality and recurrence rates are still high.
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10
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Suter KJL, Fairweather L, Al-Habbal Y, Houli N, Jacobs R, Bui HT. How to isolate a high output enteroatmospheric fistula in the open abdomen with negative pressure therapy: an institution's step by step guide to the VAC donut. ANZ J Surg 2023; 93:682-686. [PMID: 36629275 DOI: 10.1111/ans.18270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/31/2022] [Indexed: 01/12/2023]
Abstract
There is multiple evidence to suggest that isolation techniques of high output enteroatmospheric fistulas (EAF) in open abdomens can be advantageous in controlling fistula effluent while allowing time for abdominal wall to granulate. The large loss of proteins, electrolytes and fluid, and the distressing nature of the open abdomen for both patients and doctors, make managing these EAFs a clinical challenge. We present our experience with a high output mucosal protruding EAF and the creation of a 'VAC donut' allowing a successful diversion of the enteric content whilst promoting granulation of the tissue bed.
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Affiliation(s)
- Katherine J L Suter
- Department of Upper Gastrointestinal and General Surgery, Western Health, Melbourne, Victoria, Australia
| | - Luke Fairweather
- Department of Upper Gastrointestinal and General Surgery, Western Health, Melbourne, Victoria, Australia
| | - Yayha Al-Habbal
- Department of Upper Gastrointestinal and General Surgery, Western Health, Melbourne, Victoria, Australia
| | - Nezor Houli
- Department of Upper Gastrointestinal and General Surgery, Western Health, Melbourne, Victoria, Australia
| | - Rodney Jacobs
- Department of Upper Gastrointestinal and General Surgery, Western Health, Melbourne, Victoria, Australia
| | - Hai T Bui
- Department of Upper Gastrointestinal and General Surgery, Western Health, Melbourne, Victoria, Australia
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Teduglutide for the treatment of low-output enterocutaneous fistula – a pilot randomized controlled study. Clin Nutr ESPEN 2022; 50:49-55. [DOI: 10.1016/j.clnesp.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/23/2022] [Accepted: 04/30/2022] [Indexed: 11/21/2022]
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Cioffi SPB, Chiara O, Del Prete L, Bonomi A, Altomare M, Spota A, Bini R, Cimbanassi S. Failure to Rescue (FTR) and Pitfalls in the Management of Complex Enteric Fistulas (CEF): From Rescue Surgery to Rescue Strategy. J Pers Med 2022; 12:jpm12020292. [PMID: 35207780 PMCID: PMC8875978 DOI: 10.3390/jpm12020292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Complex enteric fistulas (CEF) represent general surgeons’ nightmare. This paper aims to explore the impact on failure-to-rescue (FTR) rate of a standardised and integrated surgical and critical care step-up approach. Methods: This was a retrospective observational cohort study. Patients treated for CEF from 2009 to 2019 at Niguarda Hospital were included. Each patient was approached following a three-step approach: study phase, sepsis control and strategy definition phase, and surgical rescue phase. Results: Sixteen patients were treated for CEF. Seven fistulas were classified as complex entero-cutaneous (ECF) and nine as entero-atmospheric fistula (EAF). Median number of surgical procedures for fistula control before definitive surgical attempt was 11 (IQR 2–33.5). The median time from culprit surgery and the first access at Niguarda Hospital to definitive surgical attempt were 279 days (IQR 231–409) and 120 days (IQR 34–231), respectively. Median ICU LOS was 71 days (IQR 28–101), and effective hospital LOS was 117 days, (IQR 69.5–188.8). Three patients (18.75%) experienced spontaneous fistula closure after conversion to simple ECF, whereas 13 (81.25%) underwent definitive surgery for fistula takedown. Surgical rescue was possible in nine patients. Nine patients underwent multiple postoperative revision for surgical complications. Four patients failed to be rescued. Conclusion: An integrated step-up rescue strategy is crucial to standardise the approach to CEF and go beyond the basic surgical rescue procedure. The definition of FTR is dependent from the examined population. CEF patients are a unique cluster of emergency general surgery patients who may need a tailored definition of FTR considering the burden of postoperative events influencing their outcome.
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Affiliation(s)
- Stefano Piero Bernardo Cioffi
- General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.P.B.C.); (O.C.); (M.A.); (A.S.); (R.B.)
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.P.B.C.); (O.C.); (M.A.); (A.S.); (R.B.)
- Department of Pathophysiology and Transplants, State University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Luca Del Prete
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Alessandro Bonomi
- General Surgery Residency Program, State University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy;
| | - Michele Altomare
- General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.P.B.C.); (O.C.); (M.A.); (A.S.); (R.B.)
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Andrea Spota
- General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.P.B.C.); (O.C.); (M.A.); (A.S.); (R.B.)
| | - Roberto Bini
- General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.P.B.C.); (O.C.); (M.A.); (A.S.); (R.B.)
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.P.B.C.); (O.C.); (M.A.); (A.S.); (R.B.)
- Department of Pathophysiology and Transplants, State University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
- Correspondence:
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Borejsza-Wysocki M, Bobkiewicz A, Francuzik W, Krokowicz L, Walczak D, Szmeja J, Banasiewicz T. Effect of closed incision negative pressure wound therapy on incidence rate of surgical site infection after stoma reversal: a pilot study. Wideochir Inne Tech Maloinwazyjne 2021; 16:686-696. [PMID: 34950263 PMCID: PMC8669980 DOI: 10.5114/wiitm.2021.106426] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/20/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The stoma reversal (SR) procedure is associated with a relatively high risk of perioperative complications with surgical site infection (SSI) as the most common. Recently closed incision negative pressure wound therapy (ciNPWT) was applied widely to prevent SSI. AIM To investigate the efficiency of ciNPWT in terms of the incidence rate of SSI after SR surgery. MATERIAL AND METHODS As an exploratory observational cohort study patients were treated either with ciNPWT (n = 15) or standard sterile dressing (SSD) (n = 15). CiNPWT was applied every 3 days whereas SSD was changed every day. Clinical evaluation for SSI signs, C-reactive protein level and pain assessment using the visual analogue scale (VAS) were analyzed. RESULTS The incidence rate of SSI was in 13% (2/15) in the ciNPWT group and 26% (4/15) in the SSD group (p = 0.651, OR = 0.44, 95% CI: 0.03-3.73). All patients in the SSD group who developed SSI presented both local and generalized signs of infection. Pain-VAS levels assessed on the 1st (MdnciNPWT = 4, MdnSSD = 5, p = 0.027, W = 51.5) and 3rd postoperative day (MdnciNPWT = 2, MdnSSD = 4, p = 0.014, W = 45.5) were significantly lower in the ciNPWT group than in the SSD group. CONCLUSIONS CiNPWT seems not to have a benefit to reduce SSI after the SR procedure. Further investigation is needed to establish firmly the benefit of using ciNPWT in this group of patients.
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Affiliation(s)
- Maciej Borejsza-Wysocki
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Adam Bobkiewicz
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Francuzik
- Department of Dermatology, Venerology and Allergology Charité – Universitätsmedizin, Berlin, Germany
| | - Lukasz Krokowicz
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Dominik Walczak
- Department of Oncological and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Gliwice, Poland
| | - Jacek Szmeja
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Banasiewicz
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
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de Weerd L, Bakkehaug B, Gosciewska M, Norderval S. A New Extraperitoneal Method for Entero-atmospheric Fistula Closure Using a Free Muscle Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3918. [PMID: 35028255 PMCID: PMC8751776 DOI: 10.1097/gox.0000000000003918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/17/2021] [Indexed: 06/14/2023]
Abstract
Treatment of an entero-atmospheric fistula (EAF) is challenging and associated with significant morbidity and mortality. For an EAF with protrusion of mucosa, chances for spontaneous closure are minimal. Standard surgical procedures may be associated with a high risk for complications in patients with a hostile abdomen. This article describes a new method for extraperitoneal closure of an EAF in a patient with a hostile abdomen. A free segmental latissimus dorsi musculocutaneous flap was harvested on its thoracodorsal pedicle, leaving the remaining muscle innervated. The flap was anastomosed to the internal mammary vessels. The muscle was sutured into the fistula opening using a parachute technique and temporarily immobilized with a negative wound pressure device. The skin of the flap was used for monitoring and later replaced by a skin graft. The postoperative course was uneventful. At 24 months follow-up, there were no signs of recurrences. The patient had no pain and had no defecation problems. Extraperitoneal closure of an EAF with a segmental free latissimus dorsi muscle flap sutured into the fistula opening with a parachute technique may be a new promising technique in patients where standard surgical procedures are associated with too high a risk for complications and where a local pedicled muscle flap is not available. The advantages of this method are that no laparotomy is required, the intestinal lumen is not reduced in diameter, and that no bowel resection is performed, which is a particular advantage in cases with a short bowel syndrome.
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Affiliation(s)
- Louis de Weerd
- From the Department of Plastic and Reconstructive Surgery, University Hospital of North Norway, 9038 Tromsø, Norway
- Medical Imaging Research Group, Department of Clinical Medicine, Uit The Arctic University of Norway, 9037 Tromsø, Norway
| | - Bård Bakkehaug
- From the Department of Plastic and Reconstructive Surgery, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Malgorzata Gosciewska
- From the Department of Plastic and Reconstructive Surgery, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Stig Norderval
- Medical Imaging Research Group, Department of Clinical Medicine, Uit The Arctic University of Norway, 9037 Tromsø, Norway
- Department of Gastroenterological Surgery, University Hospital of North Norway, 9038 Tromsø, Norway
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Muñoz-Ruiz EO, Bravo-Flórez NM, Herrera Chaparro JA, Vallejo-Vallecilla G. Nueva técnica para control de contaminación de fístulas enteroatmosféricas en abdomen abierto Björck 4. Método de Capilaridad (MECA). REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La fístula enteroatmosférica es una patología compleja que puede ser el resultado de múltiples intervenciones quirúrgicas de la cavidad abdominal. Describimos una nueva técnica para el control de la contaminación en pacientes con fístulas enteroatmosféricas en abdomen abierto Björck 4.
Métodos. Se realizó un análisis retrospectivo de cuatro pacientes con fístulas enteroatmosféricas desarrolladas como complicación de procedimientos quirúrgicos abdominales. Se trataron integralmente por un grupo multidisciplinario de Cuidados Intensivos, Cirugía general, Soporte nutricional y Cuidado de heridas y ostomías. Se utilizó una novedosa técnica quirúrgica basada en el principio de capilaridad para mantener limpios los tejidos periostomales.
Resultados. Con esta técnica se logró el control de la contaminación abdominal en todos los pacientes y una evolución clínica satisfactoria. Posteriormente se programaron para cierre quirúrgico definitivo con éxito.
Conclusiones. El manejo de la fístula enteroatmosférica representa un reto para el cirujano y el grupo multidisciplinario que trata al paciente. Esta nueva técnica utilizada en pacientes con fístula enteroatmosférica con abdomen abierto Björck 4 se basa en el principio de capilaridad, y es eficaz en el control de la contaminación, infección y de la sepsis asociada.
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The Significance of Visceral Protection in Preventing Enteroatmospheric Fistulae During Open Abdomen Treatment in Patients With Secondary Peritonitis: A Propensity Score-matched Case-control Analysis. Ann Surg 2021; 273:1182-1188. [PMID: 31318792 DOI: 10.1097/sla.0000000000003440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the influence of a visceral protective layer (VPL) on the formation of enteroatmospheric fistulae (EAF) in open abdomen treatment (OAT) for peritonitis. BACKGROUND EAF formation is a severe complication of OAT. Despite the widespread use of OAT, there are no robust evidence-based recommendations for preventing EAF. METHODS A total of 120 peritonitis patients with secondary peritonitis as a result of a perforation of a hollow viscus or anastomotic insufficiency who had undergone OAT were included, and 14 clinical parameters were recorded in prospective OAT databases at 2 tertiary referral centers. For this analysis, patients with a VPL were assigned to the treatment group and those without a VPL to the control group. Propensity Score (PS) matching was performed. Known risk factors in OAT such as malignant disease, mortality, emergency operation, OAT duration, and fascial closure were matching variables. The influence of VPL on EAF formation was statistically evaluated using logistic regression analysis. RESULTS With 34 patients in each group, no notable differences were identified with regard to age, sex, underlying disease, mortality, emergency operation, fascial closure, and OAT duration. Overall, a mortality rate of 22.1% for OAT due to peritonitis was observed. Mean OAT duration was approximately 9 days, and secondary fascial closure was achieved in more than two-thirds of all patients. Fascial traction was used in more than 75% of cases. EAF formation was significantly more frequent in the control group (EAF formation: VPL group 2.9% vs control 26.5%; P = 0.00). In the final regression analysis, the use of VPL resulted in a significant reduction in the risk of EAF formation (odds ratio 0.08; 95% confidence interval 0.01-0.71, P = 0.02), which translates to a relative risk reduction of 89.1%. CONCLUSION VPL effectively prevents EAF formation during OAT in patients with peritonitis. We recommend the consistent use of VPL as part of a standardized OAT treatment algorithm.
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Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis 2021; 23:476-547. [PMID: 33470518 PMCID: PMC9291558 DOI: 10.1111/codi.15503] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
AIM There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.
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Affiliation(s)
- Andrew S. Miller
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Benjamin Box
- Northumbria Healthcare Foundation NHS TrustNorth ShieldsUK
| | | | - Sarah E. Duff
- Manchester University NHS Foundation TrustManchesterUK
| | | | | | | | | | | | | | - Phil J. Tozer
- St Mark’s Hospital and Imperial College LondonHarrowUK
| | - Danette Wright
- Western Sydney Local Health DistrictSydneyNew South WalesAustralia
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Huang J, Ren H, Jiang Y, Wu X, Ren J. Technique Advances in Enteroatmospheric Fistula Isolation After Open Abdomen: A Review and Outlook. Front Surg 2021; 7:559443. [PMID: 33553237 PMCID: PMC7855170 DOI: 10.3389/fsurg.2020.559443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022] Open
Abstract
Enteroatmospheric fistula (EAF) after open abdomen adds difficulties to the management and increases the morbidity and mortality of patients. As an effective measurement, reconstructing gastrointestinal tract integrity not only reduces digestive juice wasting and wound contamination, but also allows expedient restoration of enteral nutrition and intestinal homeostasis. In this review, we introduce several technologies for the temporary isolation of EAF, including negative pressure wound therapy, fistuloclysis, fistula patch, surgical covered stent, three-dimensional (3D) printing stent, and injection molding stent. The manufacture and implantation procedures of each technique with their pros and cons are described in detail. Moreover, the approach in combination with finger measurement, x-ray imaging, and computerized tomography is used to measure anatomic parameters of fistula and design appropriate 3D printer-recognizable stereolithography files for production of isolation devices. Given the active roles that engineers playing in the technology development, we call on the cooperation between clinicians and engineers and the organization of clinical trials on these techniques.
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Affiliation(s)
| | | | | | - Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
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Ehlers-Danlos syndrome type IV: a case report of a rare cause of spontaneous sigmoid perforation and enteroatmospheric fistulae in a child. Surg Case Rep 2020; 6:312. [PMID: 33289853 PMCID: PMC7724010 DOI: 10.1186/s40792-020-01051-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/16/2020] [Indexed: 01/04/2023] Open
Abstract
Background Ehlers–Danlos syndrome (EDS) type IV is a rare subtype of EDS, but has important surgical implications. Case presentation Here, we present a case of a spontaneous sigmoid perforation in a 14-year-old boy. He was initially treated with laparotomy, oversew of the sigmoid perforation and a diverting ileostomy. He developed a complete wound dehiscence and enteroatmospheric fistulae. These were managed with a combination of negative pressure wound therapy and Eakin (TG Eakin™) pouch changes. We discuss the clinical features and presentation of EDS type IV, the surgical implications of managing patients with the condition, and the challenges in management of enteroatmospheric fistulae in children. Conclusions Ehlers–Danlos syndrome type IV should be considered as a cause of any spontaneous colonic perforation in children.
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Using a bio-scanner and 3D printing to create an innovative custom made approach for the management of complex entero-atmospheric fistulas. Sci Rep 2020; 10:19862. [PMID: 33199726 PMCID: PMC7669838 DOI: 10.1038/s41598-020-74213-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
Enteroatmospheric fistulae are challenging clinical conditions that require surgical expertise and that can result in chronic debilitating conditions placing the patient in a vicious cycle characterized by non healing wounds and malnutrition. They are a complex entity that presents great variability depending on the number, shape, and size of the fistulous orifices, their debit, and the dimensions of the wound. This means that, at present, there is no device that adapts to the anatomical characteristics of each patient and manages to control the spillage of intestinal effluvium from the wound. The aim of this study is to describe the manufacturing technique and to assess the preliminary results of a custom device designed through bioscanner imaging and manufactured using 3D printing for use with negative pressure wound therapy (NPWT) in the management of enteroatmospheric fistula. A proof of concept is given, and the design of the device is presented for the first time. After obtaining images of each fistula with a bioscanner, a personalised device was designed for each patient by 3D printing shape of a prism and a hollow base, taking into account the dimensions of the fistulous area in order to perform a floating ostomy to isolate the wound from the debit enteric. The polycaprolactone (PCL) device was placed including inside the fistulous surface and surrounding it with the NPWT system in order to accelerate wound healing.
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Freund MR, Reissman P, Spira RM, Topaz M. Innovative approach to open abdomen: converting an enteroatmospheric fistula into an easily manageable stoma. BMJ Case Rep 2020; 13:13/8/e234207. [PMID: 32847870 PMCID: PMC7451951 DOI: 10.1136/bcr-2019-234207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 52-year-old super morbidly obese patient underwent elective laparoscopic conversion of a failed silastic ring vertical gastroplasty to a Roux-en-Y gastric bypass. Following surgery, she developed an anastomotic leak which required emergent laparotomy. The patient then suffered from a complex postoperative course during which she developed an intestinal fistula which freely drained into the wound and gradually led to its complete dehiscence. Her course was further complicated by the surfacing of an enteroatmospheric fistula. This devastating complication was managed by employing the TopClosure Tension Relief system. Using the inverse maturation technique, further described in this report, we were able to progressively approximate and invert the edges of the skin around the enteroatmospheric fistula, thereby facilitating its conversion to an easily manageable stoma. Using this technique, we were able to achieve delayed primary wound closure of a grade 4 open abdomen complicated by an enteroatmospheric fistula in just under 5 weeks' time.
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Affiliation(s)
- Michael Ron Freund
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Petachia Reissman
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Ram M Spira
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
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Tatsuta K, Oshima T, Ishimatsu H, Hazama H, Ohata K. The successful management for long-term intractable enteroatmospheric fistula: A case report. Ann Med Surg (Lond) 2020; 57:253-256. [PMID: 32817789 PMCID: PMC7426484 DOI: 10.1016/j.amsu.2020.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Efficacy of open abdomen management with negative pressure wound therapy for enteroatmospheric fistula has been performed. But, few reports have shown its utility for enteroatmospheric fistula several years after onset. Presentation of case A 46 year-old woman underwent total colectomy due to total ulcerative colitis in her twenties. Three years before the onset of enteroatmospheric fistula, she underwent simple total hysterectomy for uterine smooth muscle tumor. Small bowel obstruction occurred early and a small bowel bypass was performed. However, she had sudden abdominal pain and was diagnosed with anastomotic leakage of small bowel bypass. Although antibiotic treatment was initiated, infection was difficult to control, and a midline abdominal incision was performed, followed by the formation of enteroatmospheric fistula. She declined early surgical intervention and started receiving home parenteral nutrition with antibiotic treatment. Although central vein management was continued, catheter infection became frequent. Hence, surgical intervention was planned 30 months after the formation of enteroatmospheric fistula. Two-stage abdominal wall reconstruction using open abdomen management with negative pressure wound therapy was planned. The definitive abdominal wall reconstruction was performed 14 days after the initial operation. Finally, she was discharged without reoperation. Discussion Enteroatmospheric fistula has no overlying soft tissue and no real fistula tract. Besides these complications, there were complications of the scarred abdominal wall from intestinal fluid exposure for 30 months. Conclusion The strategy using open abdomen management with negative pressure wound therapy for long-term enteroatmospheric fistula will have a good postoperative outcome with the same as early intervention. Negative pressure wound therapy is effective in postonset enteroatmospheric fistula. It repairs abdominal wall skin damage from 30-month intestinal fluid exposure. Open abdominal management was able to control infection in the perioperative period.
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Affiliation(s)
- Kyota Tatsuta
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Aoi-ku, Japan
| | - Takeshi Oshima
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Aoi-ku, Japan
| | - Hisato Ishimatsu
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Aoi-ku, Japan
| | - Hiroyuki Hazama
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Aoi-ku, Japan
| | - Ko Ohata
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Aoi-ku, Japan
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LapVac - a laparoscopic approach for negative pressure wound therapy application in open abdomen management: a porcine animal model. Wideochir Inne Tech Maloinwazyjne 2020; 15:112-116. [PMID: 32117493 PMCID: PMC7020723 DOI: 10.5114/wiitm.2019.86829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/06/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Negative pressure wound therapy (NPWT) in the open abdomen (OA) is recognized as a gold standard management method. Currently minimally invasive procedures are implemented in many clinical scenarios. Aim To demonstrate the feasibility of using negative pressure wound therapy in a laparoscopic approach for OA management in a porcine model termed as a laparoscopic vacuum (LapVac). Material and methods An adult female swine underwent a laparoscopic procedure. Briefly, a small incision was made and secured with a wound protector, pneumoperitoneum was created and two additional ports were placed. Then, a non-adhesive layer was precisely placed within the abdominal cavity. Results Finally, polyurethane foam and adhesive drape were applied. A volume of 200 ml of saline solution was instilled and drained completely within 30 min. We did not observe any technical problems with NPWT application. Conclusions This study confirmed the technical feasibility of NPWT application in the laparoscopic approach. LapVac seems to be a promising technique which may minimize the trauma and lead to better outcomes.
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Li Y, Li PY, Sun SJ, Yao YZ, Li ZF, Liu T, Yang F, Zhang LY, Bai XJ, Huo JS, He WB, Ouyang J, Peng L, Hu P, Zhu YA, Jin P, Shao QF, Wang YF, Dai RW, Hu PY, Chen HM, Wang GF, Wang YG, Jin HX, Zhu CJ, Zhang QY, Shao B, Sang XG, Yin CL. Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries-Update and systematic review. Chin J Traumatol 2019; 22:1-11. [PMID: 30850324 PMCID: PMC6529401 DOI: 10.1016/j.cjtee.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/12/2018] [Accepted: 01/12/2019] [Indexed: 02/07/2023] Open
Abstract
Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.
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Affiliation(s)
- Yang Li
- Trauma Center of PLA, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Pei-Yuan Li
- Trauma Center of PLA, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Shi-Jing Sun
- Trauma Center of PLA, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yuan-Zhang Yao
- Trauma Center of PLA, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Zhan-Fei Li
- Trauma Center/Department of Emergency and Trauma Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Tao Liu
- Trauma Center/Department of Emergency and Trauma Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Fan Yang
- Trauma Center/Department of Emergency and Trauma Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Lian-Yang Zhang
- Trauma Center of PLA, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
| | - Xiang-Jun Bai
- Trauma Center/Department of Emergency and Trauma Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
| | - Jing-Shan Huo
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangzhou Province, China
| | - Wu-Bing He
- Fujian Provincial Hospital, Fuzhou, China
| | - Jun Ouyang
- Emergency Surgery of the First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang Autonomous Region, China
| | - Lei Peng
- The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Ping Hu
- Chongqing Emergency Medical Center, Chongqing, China
| | - Yan-An Zhu
- Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang Province, China
| | - Ping Jin
- Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang Province, China
| | - Qi-Feng Shao
- Ninth People's Hospital of Zhengzhou, Zhengzhou, China
| | | | - Rui-Wu Dai
- Chengdu Military General Hospital, Chengdu, China
| | - Pei-Yang Hu
- Tiantai County People's Hospital, Tiantai, Zhejiang, China
| | - Hai-Ming Chen
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ge-Fei Wang
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yong-Gao Wang
- Department of Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hong-Xu Jin
- Shenyang Military General Hospital, Shenyang, China
| | - Chang-Ju Zhu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi-Yong Zhang
- The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Biao Shao
- The First People's Hospital of Kunming, Kunming, China
| | | | - Chang-Lin Yin
- The First Affiliated Hospital of Third Military Medical University, Chongqing, China
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The Difficult Abdominal Wound: Management Tips. CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-0156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wirth U, Renz BW, Andrade D, Schiergens TS, Arbogast H, Andrassy J, Werner J. Successful treatment of enteroatmospheric fistulas in combination with negative pressure wound therapy: Experience on 3 cases and literature review. Int Wound J 2018; 15:722-730. [PMID: 29600578 DOI: 10.1111/iwj.12916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 01/02/2023] Open
Abstract
Enteroatmospheric fistulas (EAF) are rare but challenging and morbid complications of abdominal surgery and require time- as well as resource-consuming management. Furthermore, they severely affect patients' quality of life. Several treatment modalities for EAF management are described in the literature. We describe 3 consecutive cases of EAF treatment by employing negative pressure wound therapy (NPWT) along with either a special silicone fistula adapter or a Silo-Vac-like system in another case to isolate the fistula from the remaining abdominal wound. Spontaneous fistula closure was achieved in 2 of the 3 cases, and surgical resection of the small bowel segment harbouring EAF opening was possible in a third case after wound conditioning. The rate of fistula closure was 100% (n = 3/3). Compartmentalisation of the contaminated area using NPWT accelerated healing of the open abdominal wound remarkably. In summary, we present a useful tool for the challenging management of EAF and review the literature on different treatment options of EAF available today.
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Affiliation(s)
- Ulrich Wirth
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany
| | - Bernhard W Renz
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany
| | - Dorian Andrade
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany
| | - Tobias S Schiergens
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany
| | - Helmut Arbogast
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany
| | - Joachim Andrassy
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany
| | - Jens Werner
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany
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Hoppe DL, Huppertz A, Ghods M. Peristomal leakage of enteroatmospheric fistulas treated with lipotransfer combined to minimal-invasive scar release technique. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-017-1345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Seternes A, Rekstad LC, Mo S, Klepstad P, Halvorsen DL, Dahl T, Björck M, Wibe A. Open Abdomen Treated with Negative Pressure Wound Therapy: Indications, Management and Survival. World J Surg 2017; 41:152-161. [PMID: 27541031 DOI: 10.1007/s00268-016-3694-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Open abdomen treatment (OAT) is a significant burden for patients and is associated with considerable mortality. The primary aim of this study was to report survival and cause of mortality after OAT. Secondary aims were to evaluate length of stay (LOS) in intensive care unit (ICU) and in hospital, time to abdominal closure and major complications. METHODS Retrospective review of prospectively registered patients undergoing OAT between October 2006 and June 2014 at Trondheim University Hospital, Norway. RESULTS The 118 patients with OAT had a median age of 63 (20-88) years. OAT indications were abdominal compartment syndrome (ACS) (n = 53), prophylactic (n = 29), abdominal contamination/second look laparotomy (n = 22), necrotizing fasciitis (n = 7), hemorrhage packing (n = 4) and full-thickness wound dehiscence (n = 3). Eight percent were trauma patients. Vacuum-assisted wound closure (VAWC) with mesh-mediated traction (VAWCM) was used in 92 (78 %) patients, the remaining 26 (22 %) had VAWC only. Per-protocol primary fascial closure rate was 84 %. Median time to abdominal closure was 12 days (1-143). LOS in the ICU was 15 (1-89), and in hospital 29 (1-246) days. Eighty-one (68 %) patients survived the hospital stay. Renal failure requiring renal replacement therapy (RRT) (OR 3.9, 95 % CI 1.37-11.11), ACS (OR 3.1, 95 % CI 1.19-8.29) and advanced age (OR 1.045, 95 % CI 1.004-1.088) were independent predictors of mortality in multivariate analysis. The nine patients with an entero-atmospheric fistula (EAF) survived. CONCLUSION Two-thirds of the patients treated with OAT survived. Renal failure with RRT, ACS and advanced age were predictors of mortality, whereas EAF was not associated with increased mortality.
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Affiliation(s)
- A Seternes
- Departments of Vascular Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway. .,Departments of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Høgskoleringen 1, 7491, Trondheim, Norway. .,Departments of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7006, Trondheim, Norway.
| | - L C Rekstad
- Departments of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway
| | - S Mo
- Departments of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway
| | - P Klepstad
- Departments of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.,Departments of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7006, Trondheim, Norway
| | - D L Halvorsen
- Departments of Urologic Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway
| | - T Dahl
- Departments of Vascular Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.,Departments of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7006, Trondheim, Norway
| | - M Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 751 85, Uppsala, Sweden
| | - A Wibe
- Departments of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.,Departments of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Høgskoleringen 1, 7491, Trondheim, Norway
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Huang JJ, Ren JA, Wang GF, Li ZA, Wu XW, Ren HJ, Liu S. 3D-printed “fistula stent” designed for management of enterocutaneous fistula: An advanced strategy. World J Gastroenterol 2017; 23:7489-7494. [PMID: 29151703 PMCID: PMC5685855 DOI: 10.3748/wjg.v23.i41.7489] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
Enterocutaneous fistulas (ECFs) are great challenges during the open abdomen. The loss of digestive juice, water-electrolyte imbalance and malnutrition are intractable issues during management of ECF. Techniques such as “fistula patch” and vacuum-assisted closure therapy have been applied to prevent contamination of open abdominal wounds by intestinal fistula drainage. However, failures are encountered due to high-output fistula and anatomical complexity. Here, we report 3D-printed patient-personalized fistula stent for ECF treatment based on 3D reconstruction of the fistula image. Subsequent follow-up demonstrated that this stent was well-implanted and effective to reduce the volume of enteric fistula effluent.
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Affiliation(s)
- Jin-Jian Huang
- Department of Surgery, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Jian-An Ren
- Department of Surgery, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
| | - Ge-Fei Wang
- Department of Surgery, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
| | - Zong-An Li
- NARI School of Electrical and Automation Engineering, Nanjing Normal University, Nanjing 210042, Jiangsu Province, China
| | - Xiu-Wen Wu
- Department of Surgery, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
| | - Hua-Jian Ren
- Department of Surgery, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
| | - Song Liu
- Department of General Surgery, Nanjing Drum Tower Hospital, Nanjing 210008, Jiangsu Province, China
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