Ten Years of Experience in the Treatment of Enteroatmospheric Fistulas at the Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Abstract

BACKGROUND: Enteroatmospheric fistulas account for 1–2% of all postoperative complications, with mortality ranging from 14–25%. Moreover, in more than 60% of cases they occur in people of working age, which determines the social significance of the problem.

AIM: To present the results of management patients with enteroatmospheric fistulas applying two-stage protocol.

METHODS: The article presents the experience of treating 169 patients with enteroatmospheric fistulas by a multidisciplinary team over the past decade at the Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine. The treatment was carried out according to a two-stage differentiated protocol developed on the basis of the SOWATS algorithm. The selection of nutritional and metabolic therapy and local management of laparostomy wounds was carried out taking into account the possibility of fistuloclysis and the type of “open abdomen” according to M. Bjork (2016).

RESULTS: A total of 169 patients were treated. At the first stage of treatment, 63 (37%) operations of preventive enterocutaneus fistulaformation were done. On other indications, 60 more operations were done. During treatment, fistulas closed in 19 (11%) patients, and 20 (12%) patients died, 8 of them from the progression of cancer. In addition, 5 (3%) patients did not undergo reconstructive surgery due to the patients’ refusal of further surgical treatment. At the second stage, 125 patients were operated on. Fistulas were eliminated simultaneously in 112 (90%) patients, the other 13 (10%) required another planned staged surgical treatment. The incidence of severe postoperative complications (Clavien-Dindo grade III–V) was 23% (29), and the overall mortality was 15% (25).

CONCLUSION: Treatment of patients with enteroatmospheric fistulas should be carried out by an experienced multidisciplinary team in compliance with current standards and approaches.

Keywords

intestinal fistula / open abdomen / fistula control / laparostomy

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