Wind Jan, van Koperen Paul J, Slors J Frederik M, Bemelman Willem A
Department of Surgery, Academic Medical Center, Postbox 22660, 1100 DD Amsterdam, the Netherlands.
Am J Surg. 2009 Jan;197(1):24-9. doi: 10.1016/j.amjsurg.2007.11.026. Epub 2008 Jul 17.
Closure of an enterocutaneous fistula and/or stomas in the presence of large abdominal wall defects is a challenging problem. In the present study, the results of the components separation technique are described.
All patients with an enterocutaneous fistula and/or stomas in the presence of large abdominal wall defects (ie, laparostomy of ventral hernia) who underwent a single-stage repair using the components separation technique in the period from January 2000 to July 2007 were reviewed retrospectively.
A total of 32 patients were included. The median operating time was 204 minutes (range 87-573). In 18 patients, additionally to the components separation, an absorbable mesh was used. Postoperatively, in 16 patients 22 complications were reported. There were 9 patients with local wound problems. The median postoperative hospital stay was 12 days (range 5-74). Seven patients developed a ventral hernia. Four of them were small asymptomatic recurrences. Four out of the 15 patients with an enterocutaneous fistula developed a recurrent fistula. The median follow-up was 20 months (range 3-54).
Closure of enterocutaneous fistula and/or stomas and simultaneous repair of large abdominal wall defects is feasible using the components separation technique but morbidity is considerable. Early recurrence of abdominal hernia and fistula is acceptable.
在存在大的腹壁缺损的情况下关闭肠皮肤瘘和/或造口是一个具有挑战性的问题。在本研究中，描述了成分分离技术的结果。
回顾性分析2000年1月至2007年7月期间所有存在大的腹壁缺损（即腹侧疝剖腹术）且使用成分分离技术进行一期修复的肠皮肤瘘和/或造口患者。
共纳入32例患者。中位手术时间为204分钟（范围87 - 573分钟）。18例患者除成分分离外还使用了可吸收补片。术后，16例患者报告了22例并发症。9例患者存在局部伤口问题。术后中位住院时间为12天（范围5 - 74天）。7例患者发生腹侧疝。其中4例为小的无症状复发。15例肠皮肤瘘患者中有4例发生复发性瘘。中位随访时间为20个月（范围3 - 54个月）。
使用成分分离技术关闭肠皮肤瘘和/或造口并同时修复大的腹壁缺损是可行的，但发病率较高。腹疝和瘘的早期复发是可以接受的。
