A method for treatment of deep and superficial enteroatmospheric fistulas in an open abdomen, ChimneyVAC: Ten years experience

• Published in: World journal of surgery 2024-05, Vol.48 (5), p.1066-1074
• Main Authors: Seternes, Arne, Rekstad, Lars Cato, Lossius, William, Wasmuth, Hans H.
• Format: Article
• Language: English
• Subjects: Adult; Cohort Studies; enteric leak; enteroatmospheric fistula; enterocutaneous fistula; Female; Humans; Intestinal Fistula - surgery; Male; Middle Aged; negative pressure wound therapy; Negative-Pressure Wound Therapy - methods; open abdomen; Open Abdomen Techniques - methods; Treatment Outcome
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1002/wjs.12156

Background Leakage of intestinal fluid is a challenging event when it appears in an open abdomen (OA) and surgical deviation does not seem possible. Intestinal contents in the abdominal cavity maintain inflammation and drainage is there for essential. We have developed a method, ChimneyVAC, to treat both deep and superficial enteroatmospheric fistulas (EAF) Aims To describe this innovative surgical technique and our 10‐year experience. Material & Methods This single‐center observational cohort study included all 16 consecutive patients treated with ChimneyVAC. Seven women and 9 men; median age: 47; (interquartile range [IQR]:39–63) years, 15 with a small bowel fistula and 1 with a large bowel fistula. All except of the colonic fistula were classified as a high output fistula; 14 were deep and 2 superficial. In this technique, a negative‐pressure source is applied directly above the fistula opening, in addition to negative pressure wound therapy for the OA. This controls the leakage of intestinal fluid by direct drainage into a vacuum system, thereby avoiding contamination of the abdomen. A controlled enterocutaneous fistula (ECF) then forms as the traction from the ChimneyVAC brings the fistula opening to skin level. Results In 14 patients, an ECF formed after a median of 42 (IQR:28–55) days and 12 (IQR:7–16) dressing changes. The median length of hospitalization was 103 (IQR:58–143) days. Two patients died of multiorgan failure and 14 initially survived. Discussion This study showed that 14 out of 16 patients survived the initial treatment for enteric leakage with the ChimneyVAC method. The outcome of ChimneyVAC treatment is a controlled ECF, which was then corrected after a median of six months. However, hospitalization is lengthy, the patients undergo several dressing changes and many needs additional parenteral nutrition until intestinal continuity is reestablished. Conclusion ChimneyVAC is a feasible method for treatment of EAF in an OA, with favorable survival.