Objective: The purpose of this study was to analyze the course and outcome of patients with combined entero-atmospheric
fistulas in
open abdomen treatment. Methods: In this retrospective observational study, we collected data on 214 patients with open abdomen complicated by entero-atmospheric
fistulas admitted to Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School from January 2012 to January 2021. We collected their basic characteristics, aetiology, treatment plan, and prognosis, including the durations of hospitalization and open treatment, time to resumption of
enteral nutrition, duration and prognosis of definitive surgery, and overall prognosis. Results: Of the 214 patients with open abdomen complicated with entero-enteral
fistulas, 23 (10.7%) died (11 of
multiple organ failure caused by abdominal
infection, five of abdominal cavity
bleeding, four of pulmonary
infection, one of airway
bleeding, one of
necrotizing fasciitis, and one of
traumatic brain injury). The remaining 191 underwent definitive surgery at our hospital. The patients who underwent definitive surgery were predominantly male (156 patients, 81.7%); their age was (46.5±2.5) years.
Trauma and gastrointestinal
tumors (120 cases, 62.8%) predominated among the primary causes. The reasons for abdominal opening were, in order, severe abdominal
infection (137 cases, 71.7%, damage control surgery (29 cases, 15.2%), and abdominal
hypertension (25 cases, 13.1%). Temporary abdominal closure measures were used to classify the participants into a skin-only
suture group (104 cases) and a skin-implant group (87 cases). Compared with the skin-implant group, in the skin-
suture-only group the proportion of male patients was lower (74.7% [65/87] vs. 87.5% [91/104], χ2=5.176, P=0.023), the mean age was older ([48.3±2.0] years vs. [45.0±1.9] years, t=-11.671, P<0.001), there were fewer patients with
trauma (32.2% [28 /87] vs. 58.7% [61/104), χ2=13.337, P<0.001),
intensive care stays were shorter ([8.9±1.0] days vs. [12.7±1.6] days, t=19.281, P<0.001), total
length of stay was shorter ([29.3±2.0] days vs. [31.9±2.0] days, t=9.021,P<0.001), there was a higher percentage of colonic
fistulas (18.4% [16/87] vs. 8.7% [9/104], χ2=3.948, P=0.047), but fewer multiple
fistulas (11.5% [10/87] vs. 34.6% [36/104], χ2=14.440, P<0.001). As to
fistula management, a higher percentage of
fistula sealing methods using 3D-printed intestinal
stents were implemented in the skin-only
suture group (60.9% [53/87] versus 43.3% [45/104], χ2=5.907, P=0.015). Compared with the implant group, the skin-only
suture group had a shorter mean time to performing provisional closure ( [9.5±0.8] days vs. [16.0±0.6] days, t=66.023, P<0.001), shorter intervals to definitive surgery ( [165.0±10.7] days vs. [198.9±8.3] days, t=26.644, P<0.001), and less use of biopatches (56.3% [49/87) vs. 71.2% [74/104], χ2=4.545, P=0.033). Conclusions: Open abdomen complicated with entero-enteral
fistulas is more common in male, and is often caused by
trauma and gastrointestinal
tumor. Severe
intra-abdominal infection is the major cause of open abdomen, and most fistulae involves the small intestine. Collection and retraction of intestinal fluid and 3D-printed entero-enteral
fistula stent sealing followed by implantation and skin-only suturing is an effective means of managing entero-enteral
fistulas complicating open abdominal cavity. Earlier closure of the abdominal cavity with skin-only
sutures can shorten the time to definitive surgery and reduce the rate of utilization of biopatches.