Abstract
Introduction. The open abdomen (OA) is often associated with complications. It has been hypothesized that negative pressure wound therapy (NPWT) in the treatment of OA may provoke enteral fistulas. Therefore, we analyzed patients with OA and NPWT with special regard to the occurrence of intestinal fistulas. Methods. The present study included all consecutive patients with OA treated with NWPT from April 2010 to August 2011 in two hospitals. Patients' demographics, indications for OA, risk factors, complications, outcome and incidence of fistulas before, during and after NPWT were recorded. Results. Of 81 patients with OA, 26 had pre-existing fistulas and 55 were free from a fistula at the beginning of NPWT. Nine of the 55 patients developed fistulas during (n = 5) or after NPWT (n = 4). Seventy-five patients received ABThera therapy, 6 patients other temporary abdominal closure devices. Only diverticulitis seemed to be a significant predisposing factor for fistulas. Mortality was slightly lower for patients without fistulas. Conclusion. The present study revealed no correlation between occurrence of fistulas before, during, and after NWPT, with diverticulitis being the only risk factor. Fistula formation during NPWT was comparable to reports from literature. Prospective studies are mandatory to clarify the impact of NPWT on fistula formation.
Highlights
IntroductionIt has been hypothesized that negative pressure wound therapy (NPWT) in the treatment of open abdomen (OA) may provoke enteral fistulas
The open abdomen (OA) is often associated with complications
Development of enteral fistulas is estimated up to 25% during the therapy of OA [3, 7,8,9], which may be caused by dryness of the small or large bowel resulting from exposition to the ambient air as well as by mechanical irritation of wound dressings [10]
Summary
It has been hypothesized that negative pressure wound therapy (NPWT) in the treatment of OA may provoke enteral fistulas. In the management of OA, the prevention of any enteral fistula is mandatory to achieve appropriate abdominal wall closure, as this in turn represents the best way to avoid further complications [14, 15]. In the treatment of OA, manifold temporary abdominal closure (TAC) methods have been described, including skin-approximation closure [16], absorbable synthetic mesh products [17], Bogota bags [18], Barker’s vacuum packing technique, and negative pressure wound therapy (NPWT) [2, 3, 19].
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