Surgical Techniques for the Management of Enteroatmospheric Fistulae
| Autor: | Georgios P. Fragulidis, Georgios Gkiokas, Athanasios Marinis, George Polymeneas, Thomas Kotsis, Dimitrios Mastorakos, Theodosios Theodosopoulos, Dionisios Voros, Georgios Anastasopoulos |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Microbiology (medical) medicine.medical_specialty medicine.medical_treatment Secondary infection Fistula Peritonitis Anastomosis Compartment Syndromes Postoperative Complications Female patient Intestinal Fistula medicine Humans Digestive System Surgical Procedures Aged business.industry General surgery High mortality Skin Transplantation Surgical Mesh medicine.disease Surgery Infectious Diseases Parenteral nutrition Female Gastrectomy business |
| Zdroj: | Surgical Infections. 10:47-52 |
| ISSN: | 1557-8674 1096-2964 |
| DOI: | 10.1089/sur.2008.044 |
| Popis: | An intestinal fistula in the "open abdomen" is called "enteroatmospheric" and is a great challenge for the surgeon because of the high mortality and morbidity rates associated with it. This report is a study of the surgical strategy for treating patients with enteroatmospheric fistulae.During a 3-year period (2005-2007), two males and one female patient with a mean age of 63 years were referred to our surgical department for management of enteroatmospheric fistulae that developed after operations carried out for severe peritonitis, which was a consequence of sigmoid diverticulum rupture in two cases and disruption of an entero-enteric Roux-en-Y anastomosis after total gastrectomy for cancer in one.All patients were appropriately supported in a surgical intensive care unit, with administration of total parenteral nutrition and appropriate antibiotics to eliminate secondary infections. Several re-operations were necessary to treat the enteroatmospheric fistulae. Eventually, all patients were discharged after a lengthy hospital stay (45-145 days).The essential principles of our operative strategy are: (1) early intervention; (2) a lateral surgical approach via the circumference of the open abdomen to avoid further damage to the exposed viscera; (3) excision of the involved bowel loop with an end-to-end anastomosis; (4) temporary abdominal closure and coverage of the open abdomen with an absorbable mesh, promoting tissue granulation; (5) skin grafting attempts; and (6) selective use of vacuum-assisted closure. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|