American journal of surgery · 2011
Treatment of small-bowel fistulae in the open abdomen with topical negative-pressure therapy.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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D'Hondt Mathieu, Devriendt Dirk, Van Rooy Frank, Vansteenkiste Franky, D'Hoore André, Penninckx Freddy, Miserez Marc
Аннотация
BACKGROUND: An open abdomen (OA) can result from surgical management of trauma, severe peritonitis, abdominal compartment syndrome, and other abdominal emergencies. Enteroatmospheric fistulae (EAF) occur in 25% of patients with an OA and are associated with high mortality.
METHODS: We report our experience with topical negative pressure (TNP) therapy in the management of EAF in an OA using the VAC (vacuum asisted closure) device (KCI Medical, San Antonio, TX). Nine patients with 17 EAF in an OA were treated with topical TNP therapy from January 2006 to January 2009. Surgery with enterectomy and abdominal closure was planned 6 to 10 weeks later.
RESULTS: Three EAF closed spontaneously. The median time from the onset of fistulization to elective surgical management was 51 days. No additional fistulae occurred during VAC therapy. One patient with a short bowel died as a result of persistent leakage after surgery.
CONCLUSIONS: Although previously considered a contraindication to TNP therapy, EAF can be managed successfully with TNP therapy. Surgical closure of EAFs is possible after several weeks.
METHODS: We report our experience with topical negative pressure (TNP) therapy in the management of EAF in an OA using the VAC (vacuum asisted closure) device (KCI Medical, San Antonio, TX). Nine patients with 17 EAF in an OA were treated with topical TNP therapy from January 2006 to January 2009. Surgery with enterectomy and abdominal closure was planned 6 to 10 weeks later.
RESULTS: Three EAF closed spontaneously. The median time from the onset of fistulization to elective surgical management was 51 days. No additional fistulae occurred during VAC therapy. One patient with a short bowel died as a result of persistent leakage after surgery.
CONCLUSIONS: Although previously considered a contraindication to TNP therapy, EAF can be managed successfully with TNP therapy. Surgical closure of EAFs is possible after several weeks.
Предметные рубрики MeSH
Abdominal CavityAbdominal Wound Closure TechniquesAdultAgedAged, 80 and overBandagesCompartment SyndromesDecompression, SurgicalDigestive System Surgical ProceduresFemaleHumansIntestinal FistulaIntestine, SmallLaparotomyMaleMiddle AgedNegative-Pressure Wound TherapyParenteral Nutrition, TotalTreatment OutcomeWound Healing