Hernia Surgery pp 379-385 | Cite as

Abdominal Wall Surgery in the Setting of an Enterocutaneous Fistula: Combined Versus Staged Definitive Repair

  • Michael G. SarrEmail author


The management of abdominal wall hernias in the presence of an enterocutaneous fistula is a difficult problem requiring mature surgical judgment. The surgeon’s primary goal is to fix the fistula, while definitive repair of the hernia should be relegated to a distant second goal and only if safe. Just because the hernia can be repaired simultaneously does not necessarily mean it should be repaired. Use of a components separation technique for abdominal wall reconstruction at the time of takedown of an enterocutaneous fistula should only be employed in good risk patients without predisposing factors for the formation of an incisional hernia. Advice/help from a reconstructive plastic surgeon to provide vascularized soft-tissue coverage of the fistula repair can be very helpful. Management of these complicated patients requires both expertise in gastrointestinal/metabolic surgery and abdominal wall reconstruction.


Incisional hernia Abdominal wall reconstruction Enterocutaneous fistula Bioprosthesis Components separation 


  1. 1.
    Johnson EK, Tushoski PL. Abdominal wall reconstruction in patients with digestive tract fistulas. Clin Colon Rectal Surg. 2010;23(3):195–208.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Visschers RG, Olde Damink SW, Winkens B, Soeters PB, van Gemert WG. Treatment strategies in 135 consecutive patients with enterocutaneous fistulas. World J Surg. 2008;32(3):445–53.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Slade DA, Carlson GL. Takedown of enterocutaneous fistula and complex abdominal wall reconstruction. Surg Clin North Am. 2013;93(5):1163–83.CrossRefPubMedGoogle Scholar
  4. 4.
    Schecter WP, Hirshberg A, Chang DS, Harris HW, Napolitano LM, Wexner SD, et al. Enteric fistulas: principles of management. J Am Coll Surg. 2009;209(4):484–91.CrossRefPubMedGoogle Scholar
  5. 5.
    Wind J, van Koperen PJ, Slors JF, Bemelman WA. Single-stage closure of enterocutaneous fistula and stomas in the presence of large abdominal wall defects using the components separation technique. Am J Surg. 2009;197(1):24–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Krpata DM, Stein SL, Eston M, Ermlich B, Blatnik JA, Novitsky YW, et al. Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown. Am J Surg. 2013;205(3):354–8. Discussion 8–9.CrossRefPubMedGoogle Scholar
  7. 7.
    de Vries Reilingh TS, Bodegom ME, van Goor H, Hartman EH, van der Wilt GJ, Bleichrodt RP. Autologous tissue repair of large abdominal wall defects. Br J Surg. 2007;94(7):791–803.CrossRefPubMedGoogle Scholar
  8. 8.
    Cheesborough JE, Park E, Souza JM, Dumanian GA. Staged management of the open abdomen and enteroatmospheric fistulae using split-thickness skin grafts. Am J Surg. 2014;207(4):504–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Blatnik J, Jin J, Rosen M. Abdominal hernia repair with bridging acellular dermal matrix—an expensive hernia sac. Am J Surg. 2008;196(1):47–50.CrossRefPubMedGoogle Scholar
  10. 10.
    Abdelfatah MM, Rostambeigi N, Podgaetz E, Sarr MG. Long-term outcomes (>5-year follow-up) with porcine acellular dermal matrix (Permacol) in incisional hernias at risk for infection. Hernia. 2015;19(1):135–40.CrossRefPubMedGoogle Scholar
  11. 11.
    Wittmann DH, Aprahamian C, Bergstein JM. Etappenlavage: advanced diffuse peritonitis managed by planned multiple laparotomies utilizing zippers, slide fastener, and Velcro analogue for temporary abdominal closure. World J Surg. 1990;14(2):218–26.CrossRefPubMedGoogle Scholar
  12. 12.
    Quyn AJ, Johnston C, Hall D, Chambers A, Arapova N, Ogston S, et al. The open abdomen and temporary abdominal closure systems—historical evolution and systematic review. Colorectal Dis. 2012;14(8):e429–38.CrossRefPubMedGoogle Scholar
  13. 13.
    Israelsson LA. Preventing and treating parastomal hernia. World J Surg. 2005;29(8):1086–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Israelsson LA. Parastomal hernias. Surg Clin North Am. 2008;88(1):113–25. ix.CrossRefPubMedGoogle Scholar
  15. 15.
    Carbonell AM, Criss CN, Cobb WS, Novitsky YW, Rosen MJ. Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg. 2013;217(6):991–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Kingsnorth AN, Shahid MK, Valliattu AJ, Hadden RA, Porter CS. Open onlay mesh repair for major abdominal wall hernias with selective use of components separation and fibrin sealant. World J Surg. 2008;32(1):26–30.CrossRefPubMedGoogle Scholar
  17. 17.
    Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990;86(3):519–26.CrossRefPubMedGoogle Scholar
  18. 18.
    Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012;204(5):709–16.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Surgery, Subspecialty General SurgeryMayo ClinicRochesterUSA

Personalised recommendations