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Classification, prevention and management of entero-atmospheric fistula: a state-of-the-art review

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Abstract

Background

Entero-atmospheric fistula (EAF) is an enteric fistula occurring in the setting of an open abdomen, thus creating a communication between the GI tract and the external atmosphere. Management and nursing of patients suffering EAF carries several challenges, and prevention of EAF should be the first and best treatment option.

Purpose

Here, we present a novel modified classification of EAF and review the current state of the art in its prevention and management including nutritional issues and feeding strategies. We also provide an overview on surgical management principles, highlighting several surgical techniques for dealing with EAF that have been reported in the literature throughout the years.

Conclusions

The treatment strategy for EAF should be multidisciplinary and multifaceted. Surgical treatment is most often multistep and should be tailored to the single patient, based on the type and characteristics of the EAF, following its correct identification and classification. The specific experience of surgeons and nursing staff in the management of EAF could be enhanced, applying distinct simulation-based ex vivo training models.

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Correspondence to Salomone Di Saverio.

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Di Saverio, S., Tarasconi, A., Walczak, D.A. et al. Classification, prevention and management of entero-atmospheric fistula: a state-of-the-art review. Langenbecks Arch Surg 401, 1–13 (2016). https://doi.org/10.1007/s00423-015-1370-3

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