Enterocutaneous fistulas constitute a serious and very complex challenge to surgeons. In this paper we present the classification of fistulas, a literature review, and our experience with the management of «enterostomic fistulas» (those presenting in patients with open abdomen, or laparostomy) where there is no skin to support them. For this type of fistulas we have successfully utilized the vacuum-assisted technique. The paper illustrates this technique, which represents an important development in the management of these patients, which also require adjuvant therapies, such as the use of somatostatin and aggressive nutritional support, parenteral or, in well selected cases, enteral.