Strategy and tactics in the treatment of 62 patients with enteroatmospheric fistula

Abstract

Background: the open abdomen is a widespread therapeutic resource. However, it is associated to complications among which enteroatmospheric fistula (EAF) is of utmost importance due to its high mortality and complex management.
Objective: to describe the strategy for management of EAF and secondarily to analyze the outcome after introduction of a change in the conservative local treatment specifically designed for EAF.
Materials and methods: from March 2002 to November 2013, patients treated for EAF were retros- pectively analyzed. They were divided into 2 groups: Group 1 (2002-2007), treated with a vacuum therapy device (Sivaco), similarly to the rest of enterocutaneous fistulae, and Group 2 (2008-2013),
treated with in a specific modality. Results of conservative and surgical treatment were described and then the two groups were statistically compared.
Results: Sixty-two patients were included. Twelve cases (19.4%) healed with conservative treatment, who were statistically associated with a baseline albumin level >3 g/dL, single lesion with no visible mucosa, marginal location and initial output <700 mL/d. In G1 the output decrease was higher, while G2 required fewer wound dressing changes and enteral nutrition was feasible in a significantly higher number of patients. Forty-seven patients underwent reconstructive surgery. Mortality was associa- ted with preoperative hypoalbuminemia and two or more anastomoses. Overall mortality was 8% (5 patients). In the multivariate model, marginal location was identified as independent predictors for spontaneous closure, whereas two or more anastomoses and hypoalbuminemia were negative inde- pendent predictors.