Surgical Techniques for the Management of Enteroatmospheric Fistulae*

Background: An intestinal fistula in the “open abdomen ” is called “enteroatmospheric ” and is a great challenge for the surgeon because of the high mortality and morbidity rates associated with it. This report is a study of the surgical strategy for treating patients with enteroatmospheric fistulae. Methods: During a 3-year period (2005–2007), two males and one female patient with a mean age of 63 years were referred to our surgical department for management of enteroatmospheric fistulae that developed after operations carried out for severe peritonitis, which was a consequence of sigmoid diverticulum rupture in two cases and disruption of an entero-enteric Roux-en-Y anastomosis after total gastrectomy for cancer in one. Results: All patients were appropriately supported in a surgical intensive care unit, with administration of to-tal parenteral nutrition and appropriate antibiotics to eliminate secondary infections. Several re-operations were necessary to treat the enteroatmospheric fistulae. Eventually, all patients were discharged after a lengthy hos-pital stay (45–145 days). Conclusions: The essential principles of our operative strategy are: (1) early intervention; (2) a lateral surgical approach via the circumference of the open abdomen to avoid further damage to the exposed viscera; (3) ex-cision of the involved bowel loop with an end-to-end anastomosis; (4) temporary abdominal closure and cov