The use of open abdomen in the management of gastrointestinal
fistula complicated with severe
intra-abdominal infection is uncommon. This study was designed to evaluate outcomes of our staged approach for the infected open abdomen. Patients who had gastrointestinal
fistula and underwent
open abdomen treatment were retrospectively reviewed. Various materials such as
polypropylene mesh and a modified sandwich package were used to achieve temporary abdominal closure followed by
skin grafting when the granulation bed matured. A delayed definitive operation was performed for final abdominal closure without implant of prosthetic mesh. Between 1999 and 2009, 56 (68.3%) of 82 patients survived through this treatment. Among them, 42 patients achieved final abdominal closure. Spontaneous
fistula closure occurred in 16 patients with secondary
fistula recorded in six patients. Besides,
wound complications occurred in 13 patients with two cases for pulmonary
infection. Within a 12-month follow-up period after definitive closure, no additional
fistula was recorded excluding planned
ventral hernia repair.
Open abdomen treatment was effective for gastrointestinal
fistula complicated by severe
intra-abdominal infection. A delayed and deliberate operative strategy aiming at
fistula excision and fascial closure, with simultaneous abdominal wall reconstruction, was required for the infected open abdomen.