Innovative technique for the abdominal wall reconstruction of complex enteroatmospheric fistula: A case report

Enteroatmospheric fistula (EAF) is a rare and devastating surgical complication with significant management challenges. Abdominal wall reconstruction (AWR) at the time of definitive repair represents the major challenge in patients with large abdominal wall defects with associated loss of abdominal domain. Herein, we describe a case of EAF with significant loss of domain for which AWR was achieved using an innovative combined approach of preoperative botulinum toxin A (BTA), extensive transversus abdominal release (TAR), and abdominal reinforcement with biosynthetic mesh. This approach achieves primary abdominal closure, providing the option of a single definitive reconstructive procedure for EAF. Further studies with long-term follow-up are required to assess the long-term durability of this approach.