The Role of Vacuum Assisted Closure in Acute Care Practice on Low-Output Abdominal Fistula: A Narrative Review

Low-output enterocutaneous fistulas (ECFs) are challenging postoperative complications that can lead to significant morbidity due to nutritional depletion, infection, and prolonged hospitalization. Vacuum-assisted closure (VAC) therapy, also referred to as negative pressure wound therapy (NPWT), has shown promise as a valuable adjunct in the acute care setting. This narrative review explores the role of VAC therapy in the management of low-output abdominal fistulas, focusing on its physiological mechanisms, technical considerations, and clinical outcomes. Evidence suggests that VAC therapy enhances granulation tissue formation, controls effluent, and facilitates spontaneous closure in up to 70 - 100% of appropriately selected cases of low-output fistulas. Closure often occurs within two to eight weeks when VAC is applied properly. Despite concerns about potential complications such as bleeding or fistula worsening, VAC remains a safe and effective strategy, particularly when traditional wound care methods fail. While the current literature is largely composed of case series and observational reports, the cumulative experience supports VAC as a frontline therapy in the acute management of low-output ECFs upon conservative measure failure. More clinical trials are needed to establish standardized treatment protocols.