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Prognostic Factors for Enteroatmospheric Fistula in Open Abdomen Treated with Negative Pressure Wound Therapy: a Multicentre Experience

Guillaume Giudicelli, A Rossetti, C Scarpa, N C Buchs, R Hompes, R J Guy, Kristjan Ukegjini, P Morel, F Ris & M Adamina

abstract

BACKGROUND
Reductions in mortality were reported with negative pressure wound therapy for laparostomy. However, some authors have voiced concern over an increased risk of enteroatmospheric fistulae. In this retrospective study, we hypothesized that surgical and metabolic derangements could increase the incidence of enteroatmospheric fistulae. We aimed to assess our experience and report long-term outcomes.

METHODS
A multicentre review of all patients with a laparostomy managed with negative pressure wound therapy between 2005 and 2015 was undertaken. Features associated with enteroatmospheric fistulae were included in multivariate logistic regression.

RESULTS
Fifty-seven patients were treated according to uniform protocol. Fourteen per cent (8/57) presented enteroatmospheric fistulae. Mesenteric ischaemia and preoperative arterial serum lactate >3.5 mmol/L were associated with a significantly increased risk of enteroatmospheric fistulae. Preoperative arterial serum lactate >3.5 mmol/L was an independent predictor of enteroatmospheric fistulae with an odds ratio of 12.41 (95% CI 1.54-99.99). All mesenteric ischaemia patients with anastomosis (5/15) presented enteroatmospheric fistulae. In-hospital mortality was 26.3% (15/57). One-year mortality was 33.3% (19/57). Incisional hernia rate was 5.2% (2/38) after 14.2 (2.4-56.3) months of follow-up.

DISCUSSION
Mesenteric ischaemia increases the risk of enteroatmospheric fistulae. Anastomosis should only be created in revascularized patients. When mesenteric vascularization is not restored, diversion is advised.
   
citation Giudicelli G, Rossetti A, Scarpa C, Buchs N C, Hompes R, Guy R J, Ukegjini K, Morel P, Ris F, Adamina M. Prognostic Factors for Enteroatmospheric Fistula in Open Abdomen Treated with Negative Pressure Wound Therapy: a Multicentre Experience. J Gastrointest Surg 2017; 21:1328-1334.
   
type journal paper/review (English)
date of publishing 23-05-2017
journal title J Gastrointest Surg (21/8)
ISSN electronic 1873-4626
pages 1328-1334
PubMed 28536807
DOI 10.1007/s11605-017-3453-7