Surgical reconstruction strategies for enteroatmospheric fistula accompanied by abdominal wall defects

Enteroatmospheric fistula (EAF) with concomitant abdominal wall defects constitutes a surgically complex complication that profoundly compromises patients’ quality of life and clinical prognosis. The reported incidence ranges from 8% to 20% among open abdomen cases, frequently correlating with extensive abdominal wall tissue damage. Staged surgical management remains the cornerstone of EAF treatment. The initial phase emphasizes infection source control and systemic stabilization through optimized drainage, targeted antibiotic therapy, and comprehensive metabolic support to minimize intra-abdominal contamination while preserving fluid-electrolyte homeostasis and nutritional status. The intermediate phase employs multimodal fistula management strategies, including controlled drainage, selective fistula occlusion, and negative pressure wound therapy, to enhance tissue repair while reducing infection risks and metabolic complications. The definitive phase focuses on surgical reconstruction to reestablish intestinal continuity and abdominal wall integrity, with repair techniques individualized according to the degree of tissue loss. Emerging innovations such as three-dimensional-printed enterocutaneous fistula stents, biologically derived meshes, and responsive smart materials have shown significant therapeutic promise. Studies indicate that personalized therapeutic protocols, which integrate advanced technologies, significantly improve clinical outcomes, reduce complications, and enhance patients’ survival rates and quality of life. Future advancements in technology are expected to enable more precise and individualized approaches to the management of EAF.