Published in:
01-12-2014 | Innovative Surgical Techniques Around the World
Vacuum-Assisted Wound Care (V.A.C.®) for Enteric Fistula Closure: How We Do It
Published in: World Journal of Surgery | Issue 12/2014
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Enterocutaneous fistulas (ECFs) are a surgical problem that is difficult to manage and they have a mortality rate between 6 and 33 % [1]. Many fistulas show a natural tendency to heal; however, the main problem in fistula care usually is adequate drainage of secretions from the wound. Vacuum-assisted wound care (V.A.C.®, Kinetic Concept, Inc., San Antonio, TX, USA) therapy can be used to treat intestinal fistulas [2‐4]. We successfully treated some cases of ECFs and enteroatmospheric fistulas (EAFs; an EAF is an ECF that opens into the base of a largely disrupted wound with exposed bowel) with the device (Table 1). In our experience, the results we obtained with V.A.C.® therapy are strictly related to some tricks used with the black sponge and negative pressure.
Table 1
Characteristics of patients with postoperative complex fistulas
|
Patient No.
|
Gender
|
Age
|
Base pathology
|
Cause of fistula
|
No. of fistulas/output
|
Site
|
Type of fistula
|
Outcome/VAC time/time of closure
|
|---|---|---|---|---|---|---|---|---|
|
1
|
F
|
71
|
Abdominal wall hernia repair. Reoperation for peritonitis
|
Leakage from inadvertent enterotomy during surgery
|
2/high
|
Ileum
|
ECF in the middle of wound, in the late postoperative period
|
Closure/25 gg/25 gg
|
|
2
|
F
|
72
|
Gastric stenosis treated with antral resection and BII reconstruction with Roux-en-Y. Two redo surgeries for peritonitis
|
Leakage from duodenal stump
Leakage from probable jejunal lesion enterotomy during surgery
|
2/high
|
Duodenum, Ileum
|
Double ECF in the same site under the right subcostal wound
|
Closure/49 gg/49 gg
|
|
3
|
M
|
40
|
IBD treated with total colectomy and ileorectal anastomosis. Reoperation for postoperative adhesion and peritonitis
|
Leakage from inadvertent enterotomy during second surgery
|
1/high
|
Ileum
|
ECF in the periumbilical site of the abdominal wound
|
Closure/50 gg/57 gg
|
|
4
|
F
|
41
|
Surgery for obesity (biliopancreatic bypass)
|
Leakage from inadvertent enterotomy during surgery
|
1/low
|
Ileum (Ansa Alimentare)
|
EAF in the open middle wound in frozen abdomen
|
Closure/41 gg/41 gg
|
|
5
|
M
|
73
|
Sigma volvulus operated on. Reoperated on twice for obstruction and peritonitis from bowel leakage
|
Leakage from sutured enterotomy during previous surgery
|
1/high
|
Ileum
|
EAF in the open middle wound in frozen abdomen
|
ECF/25 gg
|
|
6
|
F
|
76
|
Abdominal hernia repair in obese patient. Reoperation for adhesion syndrome
|
Leakage from inadvertent enterotomy during surgery
|
1/high
|
Ileum
|
EAF in the open middle wound in frozen abdomen
|
ECF/40 gg
|
|
7
|
M
|
25
|
Urgent surgery for bowel obstruction in multioperated abdomen. Redo surgery for peritonitis, multiple ileal stomas
|
Leakage from closure of ileal stoma
|
1/high
|
Ileum
|
ECF on the closure wound in the right low abdomen
|
Closure/8 gg/10 gg
|
|
8
|
M
|
28
|
Bowel resection for internal hernia in multioperated patient with IBD. Open abdomen
|
Leakage from inadvertent enterotomy during surgery
|
2/high
|
Ileum
|
EAF in frozen abdomen after open abdomen treatment; skin graft
|
ECF/45 gg
|