Study On Open Abdomen Treatment For Complicated Intra-abdominal Infection Patients With Gastrointestinal Fistula

Background Gastrointestinal fistula patients may suffer complicated intra-abdominal infection and sepsis with improper treatment,which is characterized by high mortality ranging from 20%~60%,as well as high medical costs.Gastrointestinal fistula patients with complicated intra-abdominal infections are not often diagnosed early,and proper treatment remains an unsolved problem.Therefore it is a great challenge for surgeons to repair broken intestines under complicated intra-abdominal infection conditions and to repair ruptured intestines under conditions of severe abdominal adhesions and swelling of the intestinal wall and mesentery.After the open abdominal approach was first successfully adopted to treat complicated intra-abdominal infection patients by Duff and Moffat in 1981,it gradually began to be used more widely.However,some investigators have reported that the open abdomen approach has not been effectively controlled mortality,instead,it may even increase mortality.For this reason,the approach has only been used in large medical centers rather than having been widely popularized.In the study,the researcher retrospectively analyzed 195 patients with gastrointestinal fistula complicated with intra-abdominal infection to compare the open abdominal and closed abdominal treatments.Meanwhile,the risk factors for death of patient due to treatment failure have been retrospectively analyzed as well,aiming to reduce the incidence of gastrointestinal fistula complicated with complicated abdominal infection and neonatal intestinal fistula.Aim 1.To evaluate the effects of the open abdominal approach in the treatment of gastrointestinal fistula with complicated intra-abdominal infection.2.To analyze the risk factors for death patients.? To analyze the risk factors for death in open abdomen treatment.? To analyze the risk factors for death in close abdomen treatment.?To analyze the risk factors for all dead patients.Methods We retrospectively analyzed 195 gastrointestinal fistula patients with complicated intra-abdominal infection who were received by our hospital over 7 years.These patients were divided into an open abdominal group(n=112)and a close abdominal group(n=83)according to the procedure used.We compared the mortality,hospital costs and hospital length of stay between the groups to analyze the risk factors for death in open abdomen treatment,close abdomen treatment and all death patients.Results 1.Compared with the close abdominal group,the mortality of patients in the open abdominal group had decreased and their hospital costs had been reduced as well.There were no neonatal intestinal fistulas and no significant differences in hospital length of stay between the two groups.2.A final multivariate analysis showed that delaying open abdomen was an independent risk factors for death in open abdominal treatment.However,early enteral nutrition beyond 666.67 ml was a protector factor.Acinetobacter baumannii,Pseudomonas aeruginosa,and Candida albicans were the main species in patients who died after getting open abdominal treatment.3.A final multivariate analysis also proved that early lack of enteral nutrition was an independent risk factor for death in close abdominal patients.Escherichia coli,Acinetobacter baumannii and Staphylococcus aureus were the main species in patients who died after receiving close abdominal treatment.3.A final multivariate analysis found that treatment(close abdomen),delay in the opening of the abdomen,the lack of early enteral nutrition is an independent risk factor for the death of patients.Among them.Conclusions Open abdomen can decrease the mortality and hospital costs for patients with gastrointestinal fistula with complicated intra-abdominal infection.There were no neonatal intestinal fistulas in the open abdomen group.Early open abdomen and early enteral nutrition can help to reduce mortality as well.