Experience in surgical treatment of enteroatmospheric fistulas in the late period of postoperative peritonitis

Abstract

Background. Enteroatmospheric fistulas (EAF) that occur during the use of the “open abdomen” surgical tactics are a complex surgical pathology with a high mortality rate.The aim. To assess the effectiveness of treatment of various forms of enteroatmospheric fistulas in patients with postoperative peritonitis using vacuum aspiration technology.Methods. We assessed the results of the surgical treatment of 46 patients with EAF in the late course of postoperative peritonitis (PP). Three clinical and morphological groups were distinguished: group 1 (n = 24) – EAF in small wounds of the anterior abdominal wall; group 2 (n = 15) – EAF opening into limited cavities; group 3 (n = 7) – EAF opening into laparostoma wounds. In group 1, a fistula was formed using continuous aspiration devices or VAC systems. In group 2, we used continuous aspiration of intestinal contents from the cavity. In group 3, laparostoma was treated using vacuum devices with isolation of the intestinal fistula and simulation of a floating enterostoma.Results. Group 3 of patients with EAF was characterized by a high flow rate (1224.2 ± 210.3 ml), duration of treatment (87.3 ± 12.5 day), extensive laparostoma (335.4 ± 14.3 сm2), high mortality rate (57.1 %). The best results of treatment were obtained in groups 1 and 2. The flow rate was 675.8 ± 154.3 and 541.3 ± 114.1 ml, the duration of treatment was 2 or 3 times less (37.7 ± 6.1 and 26.4 ± 5.2 days), the mortality rate was 8.3 % and 6.7 % respectively.Conclusion. EAF that occur when using the “open abdomen” surgical tactics due to the impossibility of their isolation in extensive wounds of the anterior abdominal wall are complicated clinical and morphological forms. For their treatment, it is advisable to use VAC systems, aimed at the treatment of both the anterior abdominal wall wound itself and the intestinal fistula opening into it for its gradual extraterritorialization by modeling a floating enterostoma in a vacuum device.