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Abdominal wall reconstruction in patients with enterocutaneous fistulas

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Abstract

Enterocutaneous fistulas (ECFs) remain a feared complication of surgery, particularly in acute care and trauma patients. Despite advances in medical and surgical therapies, ECFs are associated with significant morbidity and mortality; in addition, significant health care resources are consumed in their treatment. Because of the frequency nowadays of open-abdomen and damage-control surgery, of aggressive treatment for abdominal compartment syndrome, and of necrotizing soft tissue infections of the abdominal wall, ECFs are becoming common; so are enteroatmospheric fistulas (EAFs), which represent a new entity where the lumen of the intestine is directly exposed to the outside environment and has no track through subcutaneous or cutaneous tissue. The surgical management of abdominal wall defects, including ECFs and/or EAFs, is often associated with major hernias and other complexities. Careful planning and advanced surgical techniques are required, often involving the use, alone or in combination, of biologic mesh and composite tissue transfer. The treatment of ECFs in patients with large abdominal wall defects is challenging, but with proper techniques, the results can be excellent. Biologic mesh is the mesh of choice in such patients.

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References

  1. Ventral Hernia Working Group, Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery. 2010;148:544–58.

    Article  PubMed  Google Scholar 

  2. Ramsay PT, Mejia VA. Management of enteroatmospheric fistulae in the open abdomen. Am Surg. 2010;76:637–9.

    PubMed  Google Scholar 

  3. Hounsfield GN. Computerized transverse axial scanning (tomography). 1. Description of system. Br J Radiol. 1973;46:1016–22.

    Article  PubMed  CAS  Google Scholar 

  4. Gerzof SG, Robbins AH, Birkett DH, Johnson WC, Pugatch RD, Vincent ME. Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography. AJR Am J Roentgenol. 1979;133:1–8.

    PubMed  CAS  Google Scholar 

  5. Lloyd DAJ, Gabe SM, Windsor ACJ. Nutrition and management of enterocutaneous fistula. Br J Surg. 2006;93:1045–55.

    Article  PubMed  CAS  Google Scholar 

  6. Campos AC, Andrade DF, Campos GM, Matias JE, Coelho JC. A multivariate model to determine prognostic factors in gastrointestinal fistulas. J Am Coll Surg. 1999;188:483–90.

    Article  PubMed  CAS  Google Scholar 

  7. Li J, Ren J, Zhu W, Yin L, Han J. Management of enterocutaneous fistulas: 30-year clinical experience. Chin Med J (Engl). 2003;116:171–5.

    Google Scholar 

  8. Hollington P, Mawdsley J, Lim W, Gabe SM, Forbes A, Windsor AJ. An 11-year experience of enterocutaneous fistula. Br J Surg. 2004;91:1646–51.

    Article  PubMed  CAS  Google Scholar 

  9. Edmunds LH, Williams GM, Welch CE. External fistulas arising from the gastrointestinal tract. Ann Surg. 1960;152:445–71.

    Article  PubMed  Google Scholar 

  10. Berry SM, Fischer JE. Classification and pathophysiology of enterocutaneous fistulas. Surg Clin North Am. 1996;76:1009–18.

    Article  PubMed  CAS  Google Scholar 

  11. Evenson AR, Fischer JE. Current management of enterocutaneous fistula. J Gastrointest Surg. 2006;10:455–64.

    Article  PubMed  Google Scholar 

  12. Soeters PB, Ebeid AM, Fischer JE. Review of 404 patients with gastrointestinal fistulas. Impact of parenteral nutrition. Ann Surg. 1979;190:189–202.

    Article  PubMed  CAS  Google Scholar 

  13. Lévy E, Frileux P, Cugnenc PH, Honiger J, Ollivier JM, Parc R. High-output external fistulae of the small bowel: management with continuous enteral nutrition. Br J Surg. 1989;76:676–9.

    Article  PubMed  Google Scholar 

  14. Torres AJ, Land JI, Moreno-Azcoita M, Argüello JM, Silecchia G, Castro J, Hernandez-Merlo F, Jover JM, Moreno-Gonzales E, Balibrea JL. Somatostatin in the management of gastrointestinal fistulas. A multicenter trial. Arch Surg. 1992;127:97–9.

    PubMed  CAS  Google Scholar 

  15. Sancho JJ, di Costanzo J, Nubiola P, Larrad A, Beguiristain A, Roqueta F, Franch G, Oliva A, Gubern JM, Sitges-Serra A. Randomized double-blind placebo-controlled trial of early octreotide in patients with postoperative enterocutaneous fistula. Br J Surg. 1995;82:638–41.

    Article  PubMed  CAS  Google Scholar 

  16. Nubiola-Calonge P, Badía JM, Sancho J, Gil MJ, Segura M, Sitges-Serra A. Blind evaluation of the effect of octreotide (SMS 201-995), a somatostatin analogue, on small-bowel fistula output. Lancet. 1987;2:672–4.

    Article  PubMed  CAS  Google Scholar 

  17. Hernández-Aranda JC, Gallo-Chico B, Flores-Ramírez LA, Avalos-Huante R, Magos-Vázquez FJ, Ramírez-Barba EJ. Treatment of enterocutaneous fistula with or without octreotide and parenteral nutrition. Nutr Hosp. 1996;11:226–9.

    PubMed  Google Scholar 

  18. Joyce MR, Dietz DW. Management of complex gastrointestinal fistula. Curr Probl Surg. 2009;46:384–430.

    Article  PubMed  Google Scholar 

  19. Schecter WP, Hirshberg A, Chang DS, Harris HW, Napolitano LM, Wexner SD, Dudrick SJ. Enteric fistulas: principles of management. J Am Coll Surg. 2009;209:484–91.

    Article  PubMed  Google Scholar 

  20. Draus JM Jr, Huss SA, Harty NJ, Cheadle WG, Larson GM. Enterocutaneous fistula: are treatments improving? Surgery 2006;140:570–6 (discussion 576–8).

    Article  PubMed  Google Scholar 

  21. Lynch AC, Delaney CP, Senagore AJ, Connor JT, Remzi FH, Fazio VW. Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery. Ann Surg. 2004;240:825–31.

    Article  PubMed  Google Scholar 

  22. Martinez JL, Luque-de-Leon E, Mier J, Blanco-Benavides R, Robledo F. Systematic management of postoperative enterocutaneous fistulas: factors related to outcomes. World J Surg 2008;32:436–43.

    Article  PubMed  Google Scholar 

  23. Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconst Surg. 1990;86:519–26.

    Article  PubMed  CAS  Google Scholar 

  24. Shestak KC, Edington HJ, Johnson RR. The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg. 2000;105:731–8.

    Article  PubMed  CAS  Google Scholar 

  25. Rodriguez ED, Bluebond-Langner R, Silverman RP, Bochicchio G, Yao A, Manson PN, Scalea T. Abdominal wall reconstruction following severe loss of domain: the R Adams Cowley Shock Trauma Center algorithm. Plast Reconstr Surg. 2007;120:669–80.

    Article  PubMed  CAS  Google Scholar 

  26. Liu L, Li JS, Li N, Ren JA, Zhao YZ. Reconstruction of infected complex abdominal wall defects with autogenous pedicled demucosalized small intestinal sheet. Surgery. 2009;145:114–9.

    Article  PubMed  Google Scholar 

  27. Kushimoto S, Yamamoto Y, Aiboshi J, Ogawa F, Koido Y, Yoshida R, Kawai M. Usefulness of the bilateral anterior rectus abdominis sheath turnover flap method for early fascial closure in patients requiring open abdominal management. World J Surg. 2007;31:2–8 (discussion 9–10).

    Article  PubMed  Google Scholar 

  28. Szczerba SR, Dumanian GA. Definitive surgical treatment of infected or exposed ventral hernia mesh. Ann Surg. 2003;237:437–41.

    PubMed  Google Scholar 

  29. Samson TD, Buchel EW, Garvey PB. Repair of infected abdominal wall hernias in obese patients using autologous dermal grafts for reinforcement. Plast Reconstr Surg. 2005;116:523–7 (discussion 528).

    Article  PubMed  CAS  Google Scholar 

  30. Connolly PT, Teubner A, Lees NP, Anderson ID, Scott NA, Carlson GL. Outcome of reconstructive surgery for intestinal fistula in the open abdomen. Ann Surg. 2008;247:440–4.

    Article  PubMed  Google Scholar 

  31. Butler CE, Langstein HN, Kronowitz SJ. Pelvic, abdominal, and chest wall reconstruction with AlloDerm in patients at increased risk for mesh-related complications. Plast Reconstr Surg. 2005;116:1263–75 (discussion 1276–7).

    Article  PubMed  CAS  Google Scholar 

  32. Matthews MS. Abdominal wall reconstruction with an expanded rectus femoris flap. Plast Reconstr Surg. 1999;104:183–6.

    Article  PubMed  CAS  Google Scholar 

  33. Becker HP, Willms A, Schwab R. Small bowel fistulas and the open abdomen. Scand J Surg. 2007;96:263–71.

    PubMed  CAS  Google Scholar 

  34. Patton JH Jr, Berry S, Kralovich KA. Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions. Am J Surg. 2007;193:360–3.

    Article  PubMed  Google Scholar 

  35. Kim H, Bruen K, Vargo D. Acellular dermal matrix in the management of high-risk abdominal wall defects. Am J Surg. 2006;192:705–9.

    Article  PubMed  Google Scholar 

  36. Awad S, Baumann D, Bellows C et al. Prospective multicenter clinical study of single-stage repair of infected or contaminated abdominal incisional hernias using Strattice™ reconstructive tissue matrix. (RICH study) Poster Presentation at the American College of Surgeons 2010 Clinical Congress, Washington, DC, 3–7 October 2010.

  37. Chavez L, Latifi R, O’Keefe K et al. Are biologic mesh repairs the answer for complicated abdominal wall defects and for patients with enterocutaneous fistulae? In: Oral presentation at the 11th European Congress of Trauma and Emergency Surgery, Brussels, Belgium, 18 May 2010.

  38. de Moya MA, Dunham M, Inaba K, Bahouth H, Alam HB, Sultan B, Namias N. Long-term outcome of acellular dermal matrix when used for large traumatic open abdomen. J Trauma. 2008;65:349–53.

    Article  PubMed  Google Scholar 

  39. Jernigan TW, Fabian TC, Croce MA, Moore N, Pritchard FE, Minard G, Bee TK. Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg. 2003;238:349–55 (discussion 355–7).

    PubMed  Google Scholar 

  40. Fischer JE. The importance of reconstruction of the abdominal wall after gastrointestinal fistula closure. Am J Surg. 2009;197:131–2.

    Article  PubMed  Google Scholar 

  41. American College of Surgeons National Surgical Quality Improvement Program. Home page at: http://www.acsnsqip.org.

  42. Diaz JJ Jr, Guy J, Berkes MB, Guillamondegui O, Miller RS. Acellular dermal allograft for ventral hernia repair in the compromised surgical field. Am Surg. 2006;72:1181–7 (discussion 1187–8).

    PubMed  Google Scholar 

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Conflict of interest

Dr. Latifi, serves as Speaker for LifeCell Corporation.

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Authors and Affiliations

  1. Department of Surgery, Trauma, Surgical Critical Care and Emergency Surgery, University of Arizona, 1501 N. Campbell Avenue, Tucson, 85724, AZ, USA

    R. Latifi & M. Gustafson

  2. Department of Surgery, Trauma and Surgical Critical Care, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar

    R. Latifi

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  1. R. Latifi
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  2. M. Gustafson
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Correspondence to R. Latifi.

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Latifi, R., Gustafson, M. Abdominal wall reconstruction in patients with enterocutaneous fistulas. Eur J Trauma Emerg Surg 37, 241–250 (2011). https://doi.org/10.1007/s00068-011-0108-3

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  • DOI: https://doi.org/10.1007/s00068-011-0108-3

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