scholarly journals Challenge of uncontrolled enteroatmospheric fistulas

2019 ◽  
Vol 4 (1) ◽  
pp. e000381
Author(s):  
Daniel Jonathan Gross ◽  
Michael C Smith ◽  
Bardiya Zangbar-Sabegh ◽  
Kenneth Chao ◽  
Erin Chang ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Control Technique ◽  
Source Control ◽  
Surgical Intensive Care Unit ◽  
Closure Device ◽  
Surgical Intensive Care ◽  
The Individual ◽  
Temporary Closure

IntroductionWith the popularization of damage control surgery and the use of the open abdomen, a new permutation of fistula arose; the enteroatmospheric fistula (EAF), an opening of exposed intestine spilling uncontrollably into the peritoneal cavity. EAF is the most devastating complication of the open abdomen. We describe and analyze a single institution’s experience in controlling high-output EAFs in patients with peritonitis.MethodsWe analyzed 189 consecutive procedures to achieve and maintain definitive control of 24 EAFs in 13 patients between 2006 and 2017. EAFs followed surgery for either trauma (seven patients) or non-traumatic abdominal conditions (six patients). All procedures were mapped onto an operative timeline and analyzed for: success in achieving definitive control, number of reoperations, and feasibility of bedside procedures in the surgical intensive care unit. The end point was controlled enteric drainage through a healed abdominal wound.ResultsThere was a mean delay of 8.5 days (range 2–46 days) from the index operation until the EAF was identified. Most EAFs required several attempts (mean: 2.7 per patient, range 1–7) until definitive control was achieved. Multiple reoperations were then required to maintain control (mean: 13). While the most effective techniques were endoscopic (1) and proximal diversion (1), these were applicable only in select circumstances. A ‘floating stoma’ where the fistula edges are sutured to an opening in a temporary closure device, while technically effective, required multiple reoperations. Tube drainage through a negative pressure dressing (tube vac) required the most maintenance usually through bedside procedures. Primary closure almost always failed. Twelve of the 13 patients survived.ConclusionAn EAF is a highly complex surgical challenge. Successful source control of the potentially lethal ongoing peritonitis requires tenacity and tactical flexibility. The appropriate control technique is often found by trial and error and must be creatively tailored to the individual circumstances of the patient.

Operative Exposure of Abdominal Injuries and Closure of the Abdomen

2019 ◽  
Author(s):  
Matthew D Nealeigh ◽  
Mark W Bowyer
Keyword(s):  
Open Abdomen ◽  
Nonoperative Management ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Damage Control Resuscitation ◽  
Abdominal Injuries ◽  
Penetrating Injuries ◽  
Optimal Outcomes ◽  
Medial Rotation ◽  
Selective Nonoperative Management

Operative exposure and management of significant blunt or penetrating injuries to the abdomen is a critical skill required of all surgeons caring for victims of trauma. Application of damage control resuscitation and damage control surgical principles improves survival. Advances in diagnostics, increasing experience with selective nonoperative management, and use of endovascular and angiographic techniques have all significantly decreased the frequency of laparotomies performed for trauma. This decreasing clinical experience mandates that surgeons dealing with victims of trauma remain facile with the operative approaches and techniques detailed in this chapter to achieve optimal outcomes. Detailed management of specific injuries is covered in other chapters of this text. This review contains 7 figures, 2 tables, and 41 references.  Key Words: abdominal trauma, damage control resuscitation, damage control surgery, endovascular control of hemorrhage, open abdomen, REBOA, supraceliac control of aorta, trauma systems, visceral medial rotation

Damage Control for Thoracic Trauma

2014 ◽  
Vol 80 (9) ◽  
pp. 910-913 ◽  
Author(s):  
Michael J. Mackowski ◽  
Rebecca E. Barnett ◽  
Brian G. Harbrecht ◽  
Keith R. Miller ◽  
Glen A. Franklin ◽  
...  
Keyword(s):  
Thoracic Trauma ◽  
Injury Severity ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Control Techniques ◽  
Transfusion Requirements ◽  
University Of Louisville ◽  
Level I ◽  
Temporary Closure ◽  
Complications And Mortality

Damage control surgery involves an abbreviated operation followed by resuscitation with planned re-exploration. Damage control techniques can be used in thoracic trauma but has been infrequently reported. Our goal is to describe our experience with the use of damage control techniques in treating thoracic trauma. A retrospective analysis of all patients undergoing damage control thoracic surgery related to trauma from January 1, 2010, to January 1, 2013, at University of Louisville Hospital, a Level I trauma center. Variables studied included injury characteristics, Injury Severity Score, surgery performed, duration of packing, length of stay (LOS), ventilator days, transfusion requirements, complications, and mortality. Twenty-five patients underwent damage control surgery in the chest with packing, temporary closure, and planned re-exploration after stabilization. Seventeen patients underwent anterolateral thoracotomy, and eight patients underwent sternotomy. The mean LOS and duration of temporary packing was 20.6 and 1.4 days in the thoracotomy group, respectively, and 19.5 and 1 day in the sternotomy group, respectively. The overall mortality rate was 40 per cent, 35 per cent in the thoracotomy group and 50 per cent in the sternotomy group. Like in severe abdominal trauma, damage control techniques can be used in the management of severe thoracic injuries with acceptable results.

scholarly journals Comparative study of abdominal cavity temporary closure techniques for damage control

2016 ◽  
Vol 43 (5) ◽  
pp. 368-373 ◽  
Author(s):  
MARCELO A. F. RIBEIRO JR ◽  
EMILY ALVES BARROS ◽  
SABRINA MARQUES DE CARVALHO ◽  
VINICIUS PEREIRA NASCIMENTO ◽  
JOSÉ CRUVINEL NETO ◽  
...  
Keyword(s):  
Damage Control ◽  
Low Cost ◽  
Abdominal Cavity ◽  
Damage Control Surgery ◽  
Cellular Level ◽  
Easy Access ◽  
Vacuum Assisted Closure ◽  
Temporary Closure ◽  
Reducing Stress ◽  
Vacuum Assisted Closure Therapy

ABSTRACT The damage control surgery, with emphasis on laparostomy, usually results in shrinkage of the aponeurosis and loss of the ability to close the abdominal wall, leading to the formation of ventral incisional hernias. Currently, various techniques offer greater chances of closing the abdominal cavity with less tension. Thus, this study aims to evaluate three temporary closure techniques of the abdominal cavity: the Vacuum-Assisted Closure Therapy - VAC, the Bogotá Bag and the Vacuum-pack. We conducted a systematic review of the literature, selecting 28 articles published in the last 20 years. The techniques of the bag Bogotá and Vacuum-pack had the advantage of easy access to the material in most centers and low cost, contrary to VAC, which, besides presenting high cost, is not available in most hospitals. On the other hand, the VAC technique was more effective in reducing stress at the edges of lesions, removing stagnant fluids and waste, in addition to acting at the cellular level by increasing proliferation and cell division rates, and showed the highest rates of primary closure of the abdominal cavity.

Direct Peritoneal Resuscitation: A Novel Adjunct to Damage Control Laparotomy

2019 ◽  
Vol 39 (6) ◽  
pp. 37-45
Author(s):  
Steven Wiseman ◽  
Ellen M. Harvey ◽  
Katie Love Bower
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Care Practice ◽  
Successful Implementation ◽  
Resuscitation Strategy ◽  
Physiological Benefits ◽  
Procedural Components ◽  
Management Priorities ◽  
Abdominal Compartment

Direct peritoneal resuscitation is a validated resuscitation strategy for patients undergoing damage control surgery for hemorrhage, sepsis, or abdominal compartment syndrome with open abdomen and planned reexploration after a period of resuscitation in the intensive care unit. Direct peritoneal resuscitation can decrease visceral edema, normalize body water ratios, accelerate primary abdominal wall closure after damage control surgery, and prevent complications associated with open abdomen. This review article describes the physiological benefits of direct peritoneal resuscitation, how this technique fits within management priorities for the patient in shock, and procedural components in the care of open abdomen surgical patients receiving direct peritoneal resuscitation. Strategies for successful implementation of a novel multidisciplinary intervention in critical care practice are explored.

The open abdomen

2021 ◽  
pp. 1179-1184
Author(s):  
Omar A. Khan ◽  
Emma Rose McGlone ◽  
Marcus Reddy
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Temporary Abdominal Closure ◽  
Systemic Complications ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Local And Systemic Complications ◽  
Abdominal Compartment

This chapter introduces the concept of the open abdomen and describes the various aetiologies of this complex condition, including the rationale for elective laparostomy in damage control surgery and as a treatment for abdominal compartment syndrome. The significance of the open abdomen is described in terms of its local and systemic complications, which form the basis of the established classification. Important considerations in the acute systemic management of patients with this condition are outlined, and methods of temporary abdominal closure are described. Advantages and disadvantages of these alternatives, including the use of negative-pressure wound therapy, are discussed.

Role of Negative Pressure Therapy as Damage Control in Soft Tissue Reconstruction for Open Tibial Fractures

2017 ◽  
Vol 33 (S 01) ◽  
pp. S08-S13 ◽  
Author(s):  
Luigi Valdatta ◽  
Pierluigi Tos ◽  
Salvatore D'Arpa ◽  
Luigi Troisi ◽  
Pellegatta Igor ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Negative Pressure ◽  
Chronic Wounds ◽  
Damage Control ◽  
Physiological State ◽  
Damage Control Surgery ◽  
Soft Tissue Reconstruction ◽  
Pressure Therapy ◽  
Temporary Closure

AbstractThe concept of damage control orthopaedics (DCO) is a strategy that focuses on managing orthopaedic injuries in polytrauma patients who are in an unstable physiological state. The concept of DCO is an extension of damage control surgery or damage limitation surgery (DCS/DLS). Recently, it has become clear that certain patients, following extensive soft tissue trauma, could benefit from the idea of DCS. In the management of severe lower extremity trauma with exposed fracture sites, aggressive early wound excision debridement, early internal fixation, and vascularized wound coverage within a few days after trauma were proposed. A negative-pressure dressing can be easily and rapidly applied to obtain a temporary closure between surgical stages. While negative pressure wound therapy (NPWT) has clear indications in the management of chronic wounds, its applications in the acute setting in victims of polytrauma are uneven. We conducted a review of the current clinical literature to evaluate the role of NPWT in this field, which points out that the negative pressure, applied immediately after the first debridement, seems to be an optimal bridge to the final reconstruction up to 7 days.

scholarly journals Current Status of the Open Abdomen Treatment for Intra-Abdominal Infection

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Yujie Yuan ◽  
Jianan Ren ◽  
Yulong He
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Fluid Management ◽  
Damage Control Surgery ◽  
Skin Grafting ◽  
Current Status ◽  
Fascial Closure ◽  
Surgical Interventions ◽  
Abdominal Infection ◽  
Intra Abdominal Infection

The open abdomen has become an important approach for critically ill patients who require emergent abdominal surgical interventions. This treatment, originating from the concept of damage control surgery, was first applied in severe traumatic patients. The ultimate goal is to achieve formal abdominal fascial closure by several attempts and adjuvant therapies (fluid management, nutritional support, skin grafting, etc.). Up to the present, open abdomen therapy becomes matured and is multistage-approached in the management of patients with severe trauma. However, its application in patients with intra-abdominal infection still presents great challenges due to critical complications and poor clinical outcomes. This review focuses on the specific use of the open abdomen in such populations and detailedly introduces current concerns and advanced progress about this therapy.

scholarly journals Predictive factors of mortality in open abdomen for abdominal sepsis: a retrospective cohort study on 113 patients

2021 ◽  
Author(s):  
Dario Tartaglia ◽  
Jacopo Nicolò Marin ◽  
Alice Maria Nicoli ◽  
Andrea De Palma ◽  
Martina Picchi ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Abdominal Sepsis ◽  
Apache Ii ◽  
Fascial Closure ◽  
Apache Ii Score ◽  
Co Morbidity ◽  
Fistula Rate

AbstractOver the past few years, the open abdomen (OA) as a part of Damage Control Surgery (DCS) has been introduced as a surgical strategy with the intent to reduce the mortality of patients with severe abdominal sepsis. Aims of our study were to analyze the OA effects on patients with abdominal sepsis and identify predictive factors of mortality. Patients admitted to our institution with abdominal sepsis requiring OA from 2010 to 2019 were retrospectively analyzed. Primary outcomes were mortality, morbidity and definitive fascial closure (DFC). Comparison between groups was made via univariate and multivariate analyses. On 1474 patients operated for abdominal sepsis, 113 (7.6%) underwent OA. Male gender accounted for 52.2% of cases. Mean age was 68.1 ± 14.3 years. ASA score was > 2 in 87.9%. Mean BMI, APACHE II score and Mannheim Peritonitis Index were 26.4 ± 4.9, 15.3 ± 6.3, and 22.6 ± 7.3, respectively. A negative pressure wound system technique was used in 47% of the cases. Overall, mortality was 43.4%, morbidity 76.6%, and DFC rate was 97.8%. Entero-atmospheric fistula rate was 2.2%. At multivariate analysis, APACHE II score (OR 1.18; 95% CI 1.05–1.32; p = 0.005), Frailty Clinical Scale (OR 4.66; 95% CI 3.19–6.12; p < 0.0001) and ASA grade IV (OR 7.86; 95% CI 2.18–28.27; p = 0.002) were significantly associated with mortality. OA seems to be a safe and reliable treatment for critically ill patients with severe abdominal sepsis. Nonetheless, in these patients, co-morbidity and organ failure remain the major obstacles to a better prognosis.

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