Ten Years of Experience in the Treatment of Enteroatmospheric Fistulas at the Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

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BACKGROUND: Enteroatmospheric fistulas account for 1–2% of all postoperative complications, with mortality ranging from 14–25%. Moreover, in more than 60% of cases they occur in people of working age, which determines the social significance of the problem.

AIM: To present the results of management patients with enteroatmospheric fistulas applying two-stage protocol.

METHODS: The article presents the experience of treating 169 patients with enteroatmospheric fistulas by a multidisciplinary team over the past decade at the Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine. The treatment was carried out according to a two-stage differentiated protocol developed on the basis of the SOWATS algorithm. The selection of nutritional and metabolic therapy and local management of laparostomy wounds was carried out taking into account the possibility of fistuloclysis and the type of “open abdomen” according to M. Bjork (2016).

RESULTS: A total of 169 patients were treated. At the first stage of treatment, 63 (37%) operations of preventive enterocutaneus fistulaformation were done. On other indications, 60 more operations were done. During treatment, fistulas closed in 19 (11%) patients, and 20 (12%) patients died, 8 of them from the progression of cancer. In addition, 5 (3%) patients did not undergo reconstructive surgery due to the patients’ refusal of further surgical treatment. At the second stage, 125 patients were operated on. Fistulas were eliminated simultaneously in 112 (90%) patients, the other 13 (10%) required another planned staged surgical treatment. The incidence of severe postoperative complications (Clavien-Dindo grade III–V) was 23% (29), and the overall mortality was 15% (25).

CONCLUSION: Treatment of patients with enteroatmospheric fistulas should be carried out by an experienced multidisciplinary team in compliance with current standards and approaches.

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作者简介

Vadim Manukovskii

Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: sekr@emergency.spb.ru
ORCID iD: 0009-0000-7727-9589
SPIN 代码: 4323-4555

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Saint Petersburg

Andrey Demko

Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine; Kirov Military Medical Academy

Email: demkoandrey@gmail.com
ORCID iD: 0000-0002-9715-5505
SPIN 代码: 3399-8762

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Kasymkhan Usenov

Kirov Military Medical Academy

Email: Kasymxan@mail.ru
ORCID iD: 0009-0005-6985-3508

MD, Adjunct

俄罗斯联邦, Saint Petersburg

Ildar Batyrshin

Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine; Kirov Military Medical Academy

Email: onrush@mail.ru
ORCID iD: 0000-0003-0241-7902
SPIN 代码: 5287-7599

MD, Dr. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Dmitry Fomin

Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

编辑信件的主要联系方式.
Email: doctordmitryfomin@yandex.ru
ORCID iD: 0009-0002-8979-2202
SPIN 代码: 7482-6066

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Valery Luft

Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: lvm_aspep@mail.ru
ORCID iD: 0000-0001-5996-825X
SPIN 代码: 2003-5693

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Saint Petersburg

Galina Pichugina

Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: gal-gal2000@mail.ru
ORCID iD: 0000-0002-3176-5300
SPIN 代码: 5559-2460

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Bibigul Kelbetova

Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: bibi.k96@mail.ru
ORCID iD: 0000-0002-1463-1116
SPIN 代码: 5716-8130

MD

诺福克岛, Saint Petersburg

Julia Ostroumova

Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: Yulia575091@yandex.ru
ORCID iD: 0000-0002-1540-7909
SPIN 代码: 8888-4280

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

参考

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2. Fig. 1. Failure of the sutures of the intestinal anastomosis. Type 2C of open abdomen by Björck.

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3. Fig. 2. Multiple small intestinal fistulas. Type 4 of open abdomen by Björck.

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