Techniques and Cost Effectiveness of Enteroatmospheric Fistula Isolation

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Author(s): 
Amy Verhaalen, RN, ACNP; Bruce Watkins, MD; Karen Brasel, MD, MPH
Start Page: 
212
End Page: 
217

Abstract:

Background. The following describes successful isolation of enteroatmospheric fistulae within a negative pressure wound therapy system (V.A.C.®, KCI, San Antonio, TX). Methods. An impermeable tubular structure was placed around the fistula with a dressing applied to the surrounding wound base, dressed with an impermeable drape and negative pressure, and then an ostomy appliance was placed over the isolated fistula stoma. Cost analysis compared traditional dressings to the NPWT isolation method. Results. All patients underwent fistula isolation with complete diversion of enteric contents. Typical dressing changes occurred 3 times per week. Four patients were discharged from the hospital prior to surgical repair. Conclusion. Successful isolation of enteroatmospheric fistulae using a NPWT system has the potential to lower healthcare system costs by allowing for earlier hospital discharge.

References: 

1. Edelmann G, Boutelier P, Branche D, Hamida B. [Small intestine fistula exposed in an evisceration (27 cases).] [Article in French]. Chirurgie. 1979;105(6):503–505.

2. Lloyd DA, Gabe SM, Windsor AC. Nutrition and management of enterocutaneous fistula. Br J Surg. 2006;93(9):1045–1055.

3. Scaff DW, Brooks AJ, Bilski T, Gallagher J, Kauder D. A technique for the management of the open abdomen in the presence of a fistula. Injury Extra. 2007;38(2):43–48.

4. Goverman J, Yelon JA, Platz JJ, Singson RC, Turcinovic M. The “Fistula VAC,” a technique for management of enterocutaneous fistula arising within the open abdomen: report of 5 cases. J Trauma. 2006;60(2):428–431.

5. Trezise F. Managing an open abdomen using Eakin cohesive. 2006. Available at: http://www.eakin.co.uk/Uploads/Docs/Managing_an_Open_Abdomen_Fleur_Trezi....

6. Kordasiewicz LM. Abdominal wound with a fistula and large amount of drainage status after incarcerated hernia repair. J Wound Ostomy Continence Nurs. 2004;31(3):150–153.

7. Wild T, Otto F, Mojarrad L, Kellner M, Götzinger P. [Vacuum therapy—basics, indications, contraindication and cost listing.] [Article in German]. Ther Umsch. 2007;64(9):495–503.