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Review

Entero-Cutaneous and Entero-Atmospheric Fistulas: Insights into Management Using Negative Pressure Wound Therapy

by
Gilda Pepe
1,
Maria Michela Chiarello
2,
Valentina Bianchi
1,
Valeria Fico
1,
Gaia Altieri
1,
Silvia Tedesco
1,
Giuseppe Tropeano
1,
Perla Molica
1,
Marta Di Grezia
1 and
Giuseppe Brisinda
1,3,*
1
Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
2
General Surgery Operative Unit, Department of Surgery, Provincial Health Authority, 87100 Cosenza, Italy
3
Department of Medicine and Surgery, Catholic School of Medicine “Agostino Gemelli”, Largo Francesco Vito 1, 00168 Rome, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(5), 1279; https://doi.org/10.3390/jcm13051279
Submission received: 24 January 2024 / Revised: 14 February 2024 / Accepted: 22 February 2024 / Published: 23 February 2024
(This article belongs to the Special Issue Minimally Invasive Emergency Surgery)
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Abstract

Enteric fistulas are a common problem in gastrointestinal tract surgery and remain associated with significant mortality rates, due to complications such as sepsis, malnutrition, and electrolyte imbalance. The increasingly widespread use of open abdomen techniques for the initial treatment of abdominal sepsis and trauma has led to the observation of so-called entero-atmospheric fistulas. Because of their clinical complexity, the proper management of enteric fistula requires a multidisciplinary team. The main goal of the treatment is the closure of enteric fistula, but also mortality reduction and improvement of patients’ quality of life are fundamental. Successful management of patients with enteric fistula requires the establishment of controlled drainage, management of sepsis, prevention of fluid and electrolyte depletion, protection of the skin, and provision of adequate nutrition. Many of these fistulas will heal spontaneously within 4 to 6 weeks of conservative management. If closure is not accomplished after this time point, surgery is indicated. Despite advances in perioperative care and nutritional support, the mortality remains in the range of 15 to 30%. In more recent years, the use of negative pressure wound therapy for the resolution of enteric fistulas improved the outcomes, so patients can be successfully treated with a non-operative approach. In this review, our intent is to highlight the most important aspects of negative pressure wound therapy in the treatment of patients with enterocutaneous or entero-atmospheric fistulas.
Keywords: enteric fistula; enterocutaneous fistula; entero-atmospheric fistula; negative pressure wound therapy; open abdomen enteric fistula; enterocutaneous fistula; entero-atmospheric fistula; negative pressure wound therapy; open abdomen

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MDPI and ACS Style

Pepe, G.; Chiarello, M.M.; Bianchi, V.; Fico, V.; Altieri, G.; Tedesco, S.; Tropeano, G.; Molica, P.; Di Grezia, M.; Brisinda, G. Entero-Cutaneous and Entero-Atmospheric Fistulas: Insights into Management Using Negative Pressure Wound Therapy. J. Clin. Med. 2024, 13, 1279. https://doi.org/10.3390/jcm13051279

AMA Style

Pepe G, Chiarello MM, Bianchi V, Fico V, Altieri G, Tedesco S, Tropeano G, Molica P, Di Grezia M, Brisinda G. Entero-Cutaneous and Entero-Atmospheric Fistulas: Insights into Management Using Negative Pressure Wound Therapy. Journal of Clinical Medicine. 2024; 13(5):1279. https://doi.org/10.3390/jcm13051279

Chicago/Turabian Style

Pepe, Gilda, Maria Michela Chiarello, Valentina Bianchi, Valeria Fico, Gaia Altieri, Silvia Tedesco, Giuseppe Tropeano, Perla Molica, Marta Di Grezia, and Giuseppe Brisinda. 2024. "Entero-Cutaneous and Entero-Atmospheric Fistulas: Insights into Management Using Negative Pressure Wound Therapy" Journal of Clinical Medicine 13, no. 5: 1279. https://doi.org/10.3390/jcm13051279

APA Style

Pepe, G., Chiarello, M. M., Bianchi, V., Fico, V., Altieri, G., Tedesco, S., Tropeano, G., Molica, P., Di Grezia, M., & Brisinda, G. (2024). Entero-Cutaneous and Entero-Atmospheric Fistulas: Insights into Management Using Negative Pressure Wound Therapy. Journal of Clinical Medicine, 13(5), 1279. https://doi.org/10.3390/jcm13051279

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