Over the last 15 years, the contemporary strategies to treat the open abdomen have reduced the lethal complications. Systematic intensive care and modern wound management in conjunction with a plastic barrier to protect the viscera and topical negative pressure on the soft tissues have reduced the development of small bowel fistulas. The literature selected for this review shows that the surgical handling of the exposed bowel, the choice of the material for temporary coverage and early progressive closure of the defect are crucial for the prevention of fistulas. At present, surgeons worldwide have adopted these principles leading to an increase of primary or delayed closure rates. When a small fistula occurs, biological dressings like human acellular dermal matrix and fibrin glue may help to seal the orifice and to treat the patient conservatively. In case of a large fistula, vacuum-assisted wound management is recommended as well. Through a separate hole in the vacuum sponge matching to the fistula, the enteric contents are sucked off while the wound bed heals and is prepared for split thickness skin graft. Surgical resection of established fistula unresponsive to conservative measures should only be performed on patients well-nourished and free of infection with a delay of at least six months. for patients with an open abdomen, surgical expertise and a well-structured management plan offer the best chances to overcome this potentially devastating condition — with or without fistula.
ScottBGFeannyMAHirshbergAEarly definitive closure of the open abdomen: A quiet revolution. Scand J Surg2005; 94: 9–14.
2.
EvensonRAFischerJETreatment of enteric fistulae in the open abdomen. Chirurg2006; 77: 594–601.
3.
DeCostaAMaking a virtue of necessity: Managing the open abdomen. ANZ J Surg2006; 76: 356–363.
4.
SchachtruppAFackeldeyVKlingeUHoerJTittelAToensCSchumpelickVTemporary closure of the abdominal wall. Hernia2002; 6: 155–162.
5.
BrockWBBarkerDEBurnsRPTemporary closure of abdominal wounds: The vacuum pack. Am Surg1995; 61: 30–35.
6.
BarkerDEGreenJMMaxwellRASmithPWMejiaVADartBWCoferJBRoeSMBurnsRPExperience with vacuumpack temporary abdominal wound closure in 258 trauma and general and vascular surgical patients. J Am Coll Surg2007; 204: 784–792.
7.
CothrenCCMooreEEJohnsonJLMooreJBBurchJMOne hundred percent fascial approximation with sequential abdominal closure of the open abdomen. Am J Surg2006; 192: 238–242.
8.
JamshidiRSchecterWPBiological dressings for the management of enteric fistulas in the open abdomen. Arch Surg2007; 142: 793–796.
9.
MillerPRMeredithJWJohnsonJ CChangMCProspective evaluation of vacuum-assisted fascial closure after open abdomen: Planned ventral hernia rate is substantially reduced. Ann Surg2004; 239: 608–614.
10.
ScottBGWelshFJPhamHQCarrickMMLiscumKRGranchiTSWallMRJMattoxKLHirshbergAEarly aggressive closure of the open abdomen. J Trauma2006; 60: 17–22.
11.
SuliburkJWDrueNWBaloghZMcKinleyBACocanourCSKozarRAMooreFAVacuum-assisted wound closure achieves early fascial closure of open abdomens after severe trauma. J Trauma2003; 55: 1155–1160.
12.
EvensonRAFischerJECurrent management of enterocutaneous fistula. J Gastrointest Surg2006; 10: 455–464.
13.
FalconiMPederzoliPThe relevance of gastrointestinal fistulae in clinical practice: A review. Gut2002; 49 (SUPPL. IV): iv.2–iv10.
14.
NagyKKFildesJJMahrCRobertsRRKrosnerSMJosephKTBarrettJExperience with three different prosthetic material in temporary abdominal wall closure. Am Surg1996; 62: 331–335.
15.
JerniganTWFabianTCCroceMAMooreNPritchardFEMinardGBeeTKStaged management of giant abdominal defects. Ann Surg2003; 238: 349–354.
16.
MayberryJCBurgessEAGoldmanRKPearsonTEBrandDMullinsRJEnterocutaneous fistula and ventral hernia after absorbable mesh prosthesis closure for trauma: The plain truth. J Trauma2004; 57: 157–163.
17.
HowdieshellTRProctorCDSternbergECuewJIMondyJSHawkinsMLTemporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen. Am J Surg2004; 188: 301–306.
18.
VertreesAKellicutDOstmanSPeoplesGShriverCEarly definitive abdominal closure using serial closure technique on injured soldiers returning from Afghanistan and Iraq. J Am Coll Surg20072006; 202:762–772.
19.
MillerPRThompsonJTFalerBJMeredithJWChangMCLate fascial closure in lieu of ventral hernia: The next step in open abdomen management. J Trauma2002; 53: 843–849.
20.
PeterssonUAcostaASBjorckMVacuum-assisted wound closure and mesh-mediated fascial traction-a novel technique for late closure of the open abdomen. World J Surg2007; ahead of print.
21.
DrausJMHussSAHartyNJCheadleWGLarsonGMEnterocutaneous fistula: are treatments improving? Surgery2006; 140: 570–578.
22.
DudrickSJMaharajARMcKelveyAAArtificial nutritional support in patients with gastrointestinal fistula. World J Surg1999; 23: 570–576.
23.
MakhdoomZAKomarMJStillCDNutrition and enterocutaneous fistulas. J Clin Gastroenterology2000; 31: 195–204.
24.
HaffejeeAASurgical management of high ouptut enterocutaneous fistulae: A 24-year experience. Curr Opin Clin Nutr Metab Care2004; 7: 309–316.
25.
JamilMAhmedUSobiaHRole of somatostatin analogues in the management of enterocutaneous fistulae. J Coll Physicians Pak2004; 14: 237–240.
26.
LloydDAGabeSMWindsorACNutrition and management of enterocutaneous fistula. Br J Surg2006; 93: 1045–1055.
27.
CollierBGuillamondeguiOCottonBDonahueRConradAGrohKRichmanJVogelTMillerRDiazJJFeeding the open abdomen. J Parenter Enter Nutr2007; 31: 410–415.
28.
ToddSRKozarRAMooreFANutrition support in adult trauma patients. Nutr Clin Pract2006; 21: 421–429.
29.
GunnLAFollmarKEWongMSLettieriSCLevinLSErdmannDManagement of enterocutaneous fistulas using negative pressure dressings. Ann Plast Surg2006; 57: 621–621.
30.
GirardSSidemanMSainDAA novel approach to the problem of intestinal fistulization in patients with open peritoneal cavities. Am J Surg2002; 184: 166–167.
31.
GovermanJYelonJAPlatzJJSingsonRCTurcinovicMThe “Fistula VAC,” a technique for management of enterocutaneous fistulae arising within the open abdomen: Report of 5 case. J Trauma2005; 60: 428–31.
32.
HirschEFRepair of an abdominal wall defect after a salvage laparotomy for sepsis. J Am Coll Surg2004; 198: 324–328.
33.
AnGWalterRJNagyKClosure of abdominal wall defects using acellular dermal matrix. J Trauma2004; 56: 1266–1275.
34.
ShestakKCEdingtonHJJohnsonRRThe separation of anatomic components technique for the reconstruction of midline abdominal wall defects: Anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg2000; 105: 731–738.
35.
VriesReilingh TSvan GoorHRosmanCBemelmansMHDe JongDvan NieuwenhovenEJvan EngelandMIBleichrodtRPComponents separation technique for the repair of large abdominal hernias. J Am Coll Surg2003; 196: 32–37.
36.
MathesSJSteinwaldPMFosterRDHoffmanWYAnthonyJPComplex abdominal wall reconstruction: A comparison of flap and mesh closure. Ann Surg2000; 232: 586–596.
37.
BanwellPEMusgraveMTopical negative pressure therapy: Mechanisms and indications. Int Wound J2004; 1: 95–106.
38.
CiresiDLCaliRFSenagoreAJAbdominal closure using nonabsorbable mesh after massive resuscitation prevents abdominal compartment syndrome and gastrointestinal fistula. Am Surg1999; 8: 720–725.
39.
BarkerDEKaufmanHJSmithLACirauloDLRichartCLBurnsRPVacuum pack technique of temporary abdominal closure: A 7-year experience with 112 patients. J Trauma2000; 48: 201–206.
40.
MillerRSMorrisJAJDiazJJJHerringMBMayAKComplications after 344 damage-control open celiotomies. J Trauma2005; 59: 1365–1371.
41.
AdkinsALRobbinsJVillalbaMBendickP. C. S.Open abdomen management of intra-abdominal sepsis. Am Surg2004; 70: 137–140.
42.
TsueiBJSkinnerJCBernardACKearneyPABoulangerBRThe open peritoneal cavity: Etiology correlates with the likelihood of fascial closure. Am Surg2004; 70: 652–656.
43.
NavsariaPHBuntingMOmoshoro-JonesJNicolAJKahnDTemporary closure of open abdominal wounds by the modified sandwich-vacuum pack technique. Br J Surg2003; 90: 718–722.
44.
TremblayLNFelicianoDVSchmidtJCavaRATchorzKMIngramWLSalomoneJPNicholasJMRozyckiGSSkin only or silo closure in the critically ill patient with an open abdomen. Am J Surg2001; 182: 670–675.
