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Changing management trends in penetrating colon trauma
J K Conrad1, K M Ferry, M L Foreman
1Department of Surgery, Baylor University Medical Center, Dallas, Texas 75246, USA.
Diseases of the Colon and Rectum
|May 2, 2000
Summary
Primary repair for penetrating colon injuries increased over time. While overall morbidity remained consistent, more destructive injuries were managed with resection and anastomosis, warranting further study for severe cases.
Area of Science:
- Trauma Surgery
- Colorectal Surgery
- Surgical Outcomes
Background:
- Recent studies advocate primary repair for all penetrating colon injuries.
- This study evaluates management trends and outcomes in response to these recommendations.
Purpose of the Study:
- To assess changes in management strategies for penetrating colon injuries.
- To evaluate the outcomes of primary repair in this patient cohort.
Main Methods:
- Retrospective review of 145 patients with penetrating colon injuries (1991-1997).
- Comparison of early (1991-1993) and late (1994-1997) periods.
- Morbidity defined by specific complications including repair failure, abscess, fistula, and sepsis.
Main Results:
- Primary repair rate increased from 71% to 87% (P=0.03).
- Resection and anastomosis for destructive injuries significantly increased in the late period (26% vs. 12%, P=0.05).
- Overall morbidity remained stable at 24% between periods, with no resection and anastomosis failures.
Conclusions:
- Increased primary repair rates were driven by more liberal use of resection and anastomosis for severe injuries.
- Suture repair was consistently used for amenable injuries.
- Further research is needed to confirm the safety of resection and anastomosis in the most severely injured patients.