Negative pressure wound therapy (NPWT) in duodenal breakdown fistulas: negative pressure fistula therapy (NPFT)?

S. Magalini, G. Pepe, V. Cozza, P. Tilli, A. La Greca, F. Longo, D. Gui

Emergency Surgery Department, Fondazione Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy. gildapepe@yahoo.it

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• Gastroenterology

OBJECTIVE: To describe for the first time in literature the specific methodology of use of negative pressure wound therapy (NPWT) for duodenal fistula through clinical cases. The constant increase of use of NPWT for complex surgical situations imposes tailored previously undescribed solutions for the technique.

PATIENTS AND METHODS: Herein, three cases of high output duodenal fistula successfully treated with Negative Pressure Wound Therapy (NPWT) are reported. The technical details for the application of NPWT to these fistulas are discussed and described.

RESULTS: All three patients recovered without the necessity of further surgical operations.

CONCLUSIONS: When using NPWT, management of high-output duodenal fistulas must rely on some degree of customization of the aspiration systems. The aim of the procedure is to put under depression the duodenal hole and surrounding tissues “all in one” and not to separate the complex wound in sectors as usually indicated. We suggest calling this technique Negative Pressure Fistula Therapy.

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