To explore the clinical efficacy, safety, and operational standards of Endoluminal Vacuum-Assisted Closure (EVAC) combined with Vacuum-Assisted Closure (VAC) in treating open abdomen complicated with enteroatmospheric fistula.

This study employed a descriptive case series design. A retrospective analysis was conducted on the clinical data of 13 patients with open abdomen and enteroatmospheric fistula admitted to Jiangyin People's Hospital from January 2020 to December 2024. All patients received EVAC (polyurethane sponge placement via endoscopy/ percutaneously) combined with VAC (polyurethane sponge covering the open wound). Main observation indicators: length of hospital stay, need for reoperation; Secondary indicators: changes in inflammatory markers (WBC, C-reactive protein, procalcitonin), improvement in nutritional status (albumin).

All 13 patients achieved wound coverage with skin grafting and management of enterocutaneous fistulas to the point of self-care. No patient required reoperation due to failure in wound or enterocutaneous fistula management. The median hospital stay was 42 (35, 98) days for the 13 patients. Changes in inflammatory and nutritional indicators before and after treatment: WBC [decreased from (19.8±8.1)×10⁹/L to (7.4±2.6)× 10⁹/L], C-reactive protein [decreased from (174.9±55.5) mg/L to (15.6±4.7) mg/L], and procalcitonin [significantly decreased from (7.1±4.4) ng/ml to (0.6±0.3) ng/ml] (P<0.01); albumin [significantly increased from (23.3±3.1) g/L to (35.6±2.8) g/L] (P<0.05). Complications: 6 cases of pain (46.2%), 10 cases of sponge displacement and obstruction (76.9%), 2 cases of mucosal bleeding (15.4%), 1 case of wound infection (7.7%), and 8 cases of adhesive intestinal obstruction (61.5%). No cases of intestinal perforation, major bleeding, or death occurred.

EVAC combined with VAC effectively controls infection, promotes granulation tissue growth, reduces wound contamination, and achieves enteral nutrition through a "internal drainage+external coverage" dual mechanism. It is a safe and effective approach for treating open abdomen with enteroatmospheric fistula.