Management of enteroatmospheric fistula thanks to new isolation technique

We aimed to present our method called as new isolation technique with stopper (NITS) to manage enteroatmospheric fistula (EAF) in an open abdomen (OA). The patient was a 71-year-old male with Hartmann colostomy and incisional hernia. A dual mesh was used for incisional hernia repair after colorectal anastomosis. The patient was urgently re-admitted to hospital due to EAF on the postoperative 30th day. The NITS application was performed twice at different times. General anesthesia was not required for the applications, but sterile conditions in operation room were provided. A Penrose drain was sutured with 5/0 polydioxanone onto the mucosa of EAF orifice. A small pool was created to protect enteric content from leakage. The leak test was performed by spilling saline into this pool. The sponge with visceral organ protector around the pool was adhered by adhesive sterile drape, and one opening was performed on drape. Negative pressure therapy was launched with -75 mmHg in continuous form. EAF was isolated from the OA wound and sponge with the help of stopper performed with adaptable and obstacle ring paste. After these two applications, EAF was converted to stoma. The anastomosis of small intestine was performed 45 days later. In our NITS system, control of EAF may be successfully provided besides prevention of loss of enteric fluid and electrolyte. Advantages of NITS: 1) Successful control in all types of EAF is possible with NITS. 2) The required material for NITS system can be found easily. 3) All types of EAF can be converted into stoma in a short time. Consequently, the therapy of EAF in Björck 4 OA patients may be carried out successfully with NITS method.

Yeni izolasyon tekniði ile enteroatmosferik fistülün yönetimi

Açýk karýnda enteroatmosferik fistül (EAF) yönetiminde týkaçla yeni izolasyon tekniði olarak adlandýrýlan yöntemimizi sunmayý amaçladýk. Hasta, Hartmann kolostomi ve insizyonel herni olan 71 yaþýnda bir erkek hastaydý. Kolorektal anastomoz sonrasý insizyonel fýtýk onarýmý için dual meç kullanýldý. Hasta, acil olarak EAF nedeniyle ameliyat sonrasý otuzuncu günde hastaneye tekrar baþvurdu. Yeni izolasyon tekniði uygulamasý iki kez farklý zamanlarda yapýldý. Genel anestezi gerekli deðildi, ancak ameliyat odasýnda steril koþullar saðlandý. Bir penroz dren, 5/0 polidioksanon ile EAF mukozasýna dikildi. Enterik içeriði sýzdýrmayan küçük bir havuz oluþturuldu. Sýzýntý testi, bu havuza serum fizyolojik dökülerek yapýldý. Havuzun etrafýndaki açýk karýn alaný organ koruyuculu süngerle ve steril dreple örtüldü. Örtü üzerinde bir açýklýk yapýldý ve sürekli formda -75 mmHg ile negatif basýnç tedavisi baþlatýldý. EAF, açýk karýn yarasýndan ve süngerden, el ile þekil verilebilen ve sýzdýrmaz halka macunu ile yapýlan týkaç yardýmýyla izole edildi. Bu iki uygulamadan sonra, EAF stomaya dönüþtürüldü. Ýnce baðýrsaðýn anastomozu 45 gün sonra yapýldý. Týkaçla yeni izolasyon tekniði sistemimizde, enterik sývý ve elektrolit kaybýný önlemenin yaný sýra EAF’nin kontrolü de saðlanabilir. Týkaçla yeni izolasyon tekniðinin üstünlükleri: 1. Her türlü EAF’de baþarýlý kontrol mümkün olabilir. 2. Sistemimiz için gerekli materyal kolayca bulunabilir. 3. Tüm EAF tipleri kýsa sürede stomaya dönüþtürülebilir. Sonuç olarak, Björck 4 açýk karýn hastalarýnda EAF tedavisi týkaçla yeni izolasyon tekniðiyle baþarýlý þekilde gerçekleþtirilebilir.