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Updated: Jul 7, 2026
04:14
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Small bowel fistulas and the open abdomen
H P Becker1, A Willms, R Schwab
1Department of General, Abdominal and Thoracic Surgery, Central Military Hospital, Koblenz, Germany. horstpeter.becker@t-online.de
Summary
Advanced open abdomen treatments, including intensive care and negative pressure therapy, significantly reduce lethal complications and small bowel fistulas. Surgical expertise and structured plans are key for managing open abdomens and preventing fistulas.
Area of Science:
- Surgical Management
- Gastroenterology
- Trauma Surgery
Background:
- Open abdomen management presents significant challenges, including lethal complications and the development of small bowel fistulas.
- Contemporary strategies have evolved over 15 years to mitigate these risks.
Purpose of the Study:
- To review current strategies for treating the open abdomen, focusing on preventing and managing small bowel fistulas.
- To highlight crucial factors influencing outcomes in open abdomen cases.
Main Methods:
- Systematic review of literature on open abdomen treatment strategies.
- Analysis of techniques including intensive care, wound management, visceral protection, and topical negative pressure.
- Evaluation of methods for fistula prevention and conservative/surgical management.
Main Results:
- Modern approaches have reduced lethal complications and small bowel fistula development.
- Key factors for fistula prevention include surgical handling of exposed bowel, temporary coverage materials, and early defect closure.
- Biological dressings and vacuum-assisted wound management are effective for small and large fistulas, respectively.
- Delayed surgical resection is reserved for refractory cases in well-selected patients.
Conclusions:
- Adoption of current principles has increased primary and delayed closure rates for open abdomens.
- Conservative management with biological dressings or vacuum-assisted wound management is preferred for fistulas when possible.
- Surgical expertise and a structured management plan are essential for successful outcomes in open abdomen patients, with or without fistula.
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