Langenbeck's Archives of Surgery

, Volume 401, Issue 5, pp 619–625 | Cite as

High risk of fistula formation in vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis—a retrospective analysis

  • Ioannis Mintziras
  • Michael Miligkos
  • Detlef Klaus Bartsch



The aim of this study was to evaluate the efficacy of vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis and to identify possible risk factors of fistula formation.


The hospital OPS-database (time period 2005–2014) was searched to identify patients treated with an open abdomen due to secondary peritonitis, who underwent vacuum-assisted closure therapy. Medical records were retrospectively analyzed for patients’ characteristics, cause of peritonitis, duration of vacuum therapy, number of relaparotomies, fascial closure rates, and risk factors of fistula formation.


Forty-three patients (19 male, 24 female) with a median age of 65 years (range 24–90 years) were identified. The major cause of secondary peritonitis was anastomotic leakage after intestinal anastomosis or bowel perforation, the median APACHE II score was 11. Median duration of VAC treatment was 12 days (range 3–88 days). Twenty of 43 (47 %) patients died from septic complications. Delayed fascial closure was obtained by suturing in 20 of 43 patients (47 %). Overall 16 of 43 (37 %) patients developed enteroatmospheric fistulas. Re-explorations after starting VAC treatment and duration of VAC therapy were significantly associated with the occurrence of enteroatmospheric fistulas (p < 0.001). ROC curve analysis determined the optimal duration of VAC therapy to reduce the risk of fistula formation at 13 days.


Long-term VAC treatment of patients with an open abdomen due to secondary peritonitis results in a relatively low fascial closure rate and a high risk of fistula formation.


Vacuum-assisted closure therapy Peritonitis Open abdomen Enterocutaneous fistula 


Authors’ contributions

I.M. is responsible for the study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical revision of manuscript; M.M is responsible for the study conception and design, analysis and interpretation of data, and critical revision of manuscript; responsible for the study conception and design, analysis and interpretation of data, drafting of manuscript, and critical revision of manuscript.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Ioannis Mintziras
    • 1
  • Michael Miligkos
    • 2
  • Detlef Klaus Bartsch
    • 1
  1. 1.Department of Visceral, Thoracic and Vascular SurgeryPhilipps-University MarburgMarburgGermany
  2. 2.Laboratory of BiomathematicsUniversity of Thessaly School of MedicineLarissaGreece

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