The open abdomen - Part 3: Management of the Grade 3 open abdomen with entero-atmospheric fistulae

Abstract

Entero-atmospheric fistulae are a disastrous complication when laparostomes have to be used in abdominal surgery. Patients must be approached from a global and localised perspective, with heavy focus on management of fluid balance, electrolytes, nutrition, and prevention of infective complications. Specialised dressing of the laparostome and fistulae is essential for optimisation of the patients condition before undertaking more definitive forms of management, as well as for dignity and quality of life. Depending on the fistula classification, the dressing method may be successful. Fistula isolation is the key concept behind these specialised dressings. Ultimately, the objectives are to achieve either spontaneous or surgical closure of the fistula, and closure of the laparostome.