Ramin Jamshidi1, William P Schecter. 1. Department of Surgery, San Francisco General Hospital and University of California, San Francisco, CA 94110, USA.
Abstract
HYPOTHESIS: Biological dressings can be effective tools in the management of enteric fistulas, which are the nemesis of exposed viscera. DESIGN: Retrospective review of medical records. SETTING: University-affiliated level I trauma center. PATIENTS: Patients with open abdominal cavities and coexistent intestinal fistulas who were treated between January 1, 1999, and July 1, 2006. INTERVENTIONS: Application of biological dressings to fistula sites within open abdominal cavities during serial fascial closure. Biological dressings included cadaveric skin, human acellular dermal matrix, and fibrin sealant. MAIN OUTCOME MEASURES: Enteric fistula closure and healing of the abdominal wound. RESULTS: During the 6 years under review, there were 69 patients with open abdomens. Of these patients, 7 (10%) developed enteric fistulas and underwent application of biological dressings. In 5 patients, fistulas closed and the abdominal wound healed after application of biological dressings. One additional patient healed after fistula resection. Biological dressing treatment and fistula resection both failed in 1 patient. There was no morbidity or mortality attributable to the intervention. CONCLUSIONS: Intestinal fistulas significantly complicate the management of patients with open abdomens. In this case series, biological dressings were effective in achieving fistula closure. A prospective multi-institutional study is required to confirm these preliminary encouraging results.
HYPOTHESIS: Biological dressings can be effective tools in the management of enteric fistulas, which are the nemesis of exposed viscera. DESIGN: Retrospective review of medical records. SETTING: University-affiliated level I trauma center. PATIENTS: Patients with open abdominal cavities and coexistent intestinal fistulas who were treated between January 1, 1999, and July 1, 2006. INTERVENTIONS: Application of biological dressings to fistula sites within open abdominal cavities during serial fascial closure. Biological dressings included cadaveric skin, human acellular dermal matrix, and fibrin sealant. MAIN OUTCOME MEASURES: Enteric fistula closure and healing of the abdominal wound. RESULTS: During the 6 years under review, there were 69 patients with open abdomens. Of these patients, 7 (10%) developed enteric fistulas and underwent application of biological dressings. In 5 patients, fistulas closed and the abdominal wound healed after application of biological dressings. One additional patient healed after fistula resection. Biological dressing treatment and fistula resection both failed in 1 patient. There was no morbidity or mortality attributable to the intervention. CONCLUSIONS:Intestinal fistulas significantly complicate the management of patients with open abdomens. In this case series, biological dressings were effective in achieving fistula closure. A prospective multi-institutional study is required to confirm these preliminary encouraging results.
Authors: Jose L Martinez; Enrique Luque-de-León; Guillermo Ballinas-Oseguera; José D Mendez; Marco A Juárez-Oropeza; Ruben Román-Ramos Journal: J Gastrointest Surg Date: 2011-10-15 Impact factor: 3.452