A method for treatment of deep and superficial enteroatmospheric fistulas in an open abdomen, ChimneyVAC: Ten years experience.
enteric leak
enteroatmospheric fistula
enterocutaneous fistula
negative pressure wound therapy
open abdomen
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
23 Mar 2024
23 Mar 2024
Historique:
received:
08
11
2023
accepted:
10
03
2024
medline:
23
3
2024
pubmed:
23
3
2024
entrez:
23
3
2024
Statut:
aheadofprint
Résumé
Leakage of intestinal fluid is a challenging event when it appears in an open abdomen (OA) and surgical deviation does not seem possible. Intestinal contents in the abdominal cavity maintain inflammation and drainage is there for essential. We have developed a method, ChimneyVAC, to treat both deep and superficial enteroatmospheric fistulas (EAF) AIMS: To describe this innovative surgical technique and our 10-year experience. This single-center observational cohort study included all 16 consecutive patients treated with ChimneyVAC. Seven women and 9 men; median age: 47; (interquartile range [IQR]:39-63) years, 15 with a small bowel fistula and 1 with a large bowel fistula. All except of the colonic fistula were classified as a high output fistula; 14 were deep and 2 superficial. In this technique, a negative-pressure source is applied directly above the fistula opening, in addition to negative pressure wound therapy for the OA. This controls the leakage of intestinal fluid by direct drainage into a vacuum system, thereby avoiding contamination of the abdomen. A controlled enterocutaneous fistula (ECF) then forms as the traction from the ChimneyVAC brings the fistula opening to skin level. In 14 patients, an ECF formed after a median of 42 (IQR:28-55) days and 12 (IQR:7-16) dressing changes. The median length of hospitalization was 103 (IQR:58-143) days. Two patients died of multiorgan failure and 14 initially survived. This study showed that 14 out of 16 patients survived the initial treatment for enteric leakage with the ChimneyVAC method. The outcome of ChimneyVAC treatment is a controlled ECF, which was then corrected after a median of six months. However, hospitalization is lengthy, the patients undergo several dressing changes and many needs additional parenteral nutrition until intestinal continuity is reestablished. ChimneyVAC is a feasible method for treatment of EAF in an OA, with favorable survival.
Sections du résumé
BACKGROUND
BACKGROUND
Leakage of intestinal fluid is a challenging event when it appears in an open abdomen (OA) and surgical deviation does not seem possible. Intestinal contents in the abdominal cavity maintain inflammation and drainage is there for essential. We have developed a method, ChimneyVAC, to treat both deep and superficial enteroatmospheric fistulas (EAF) AIMS: To describe this innovative surgical technique and our 10-year experience.
MATERIAL & METHODS
METHODS
This single-center observational cohort study included all 16 consecutive patients treated with ChimneyVAC. Seven women and 9 men; median age: 47; (interquartile range [IQR]:39-63) years, 15 with a small bowel fistula and 1 with a large bowel fistula. All except of the colonic fistula were classified as a high output fistula; 14 were deep and 2 superficial. In this technique, a negative-pressure source is applied directly above the fistula opening, in addition to negative pressure wound therapy for the OA. This controls the leakage of intestinal fluid by direct drainage into a vacuum system, thereby avoiding contamination of the abdomen. A controlled enterocutaneous fistula (ECF) then forms as the traction from the ChimneyVAC brings the fistula opening to skin level.
RESULTS
RESULTS
In 14 patients, an ECF formed after a median of 42 (IQR:28-55) days and 12 (IQR:7-16) dressing changes. The median length of hospitalization was 103 (IQR:58-143) days. Two patients died of multiorgan failure and 14 initially survived.
DISCUSSION
CONCLUSIONS
This study showed that 14 out of 16 patients survived the initial treatment for enteric leakage with the ChimneyVAC method. The outcome of ChimneyVAC treatment is a controlled ECF, which was then corrected after a median of six months. However, hospitalization is lengthy, the patients undergo several dressing changes and many needs additional parenteral nutrition until intestinal continuity is reestablished.
CONCLUSION
CONCLUSIONS
ChimneyVAC is a feasible method for treatment of EAF in an OA, with favorable survival.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Authors. World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).
Références
Schecter, William P. 2011. “Management of Enterocutaneous Fistulas.” Surgical Clinics of North America 91(3): 481–491. https://doi.org/10.1016/j.suc.2011.02.004.
Di Saverio, Salomone, Antonio Tarasconi, Dominik A. Walczak, Roberto Cirocchi, Matteo Mandrioli, Arianna Birindelli, and Gregorio Tugnoli. 2016. “Classification, Prevention and Management of Entero‐Atmospheric Fistula: a State‐Of‐The‐Art Review.” Langenbeck's Archives of Surgery 401: 1–13. https://doi.org/10.1007/s00423‐015‐1370‐3.
Björck, M., A. W. Kirkpatrick, M. Cheatham, M. Kaplan, A. Leppäniemi, and J. J. De Waele. 2016. “Amended Classification of the Open Abdomen.” Scandinavian Journal of Surgery 105(1): 5–10. https://doi.org/10.1177/1457496916631853.
Rekstad, Lars Cato, Hans H. Wasmuth, Brynjulf Ystgaard, Tore Stornes, and Arne Seternes. 2013. “Topical Negative‐Pressure Therapy for Small Bowel Leakage in a Frozen Abdomen: a Technical Report.” Journal of Trauma and Acute Care Surgery 75(3): 487–491. https://doi.org/10.1097/ta.0b013e3182995e6d.
Tavusbay, Cengiz, Hudai Genc, Necat Cin, Haldun Kar, Erdinc Kamer, Kemal Atahan, and Mehmet Haciyanli. 2015. “Use of a Vacuum‐Assisted Closure System for the Management of Enteroatmospheric Fistulae.” Surgery Today 45(9): 1102–1111. https://doi.org/10.1007/s00595‐014‐1020‐3.