Primary repair for penetrating colon injuries

Primary repair of penetrating colon injuries is an appealing management option. However, uncertainty about its safety persists.

The objective of this review was to compare morbidity and mortality rates after primary repair to the rates after fecal diversion, in the management of penetrating colon injuries, using a meta-analysis of randomized controlled trials.

We searched MEDLINE (1966 to November 2001), the Cochrane Controlled Trials Register, and EMBASE using the terms colon, penetrating, injury, colostomy, prospective, and randomized.

Studies were included if they were randomized controlled trials comparing the outcomes of primary repair versus fecal diversion in the management of penetrating colon injuries. Five studies were included.

Reviewers performed data extraction independently. Outcomes evaluated from each trial included mortality, total complications, infectious complications, intra-abdominal infections, wound complications, penetrating abdominal trauma index (PATI), and length of stay. Peto odds ratios (ORs) for combined effect were calculated with a 95% confidence interval (95% CI) for each outcome. Heterogeneity was assessed for each outcome, using a chi-squared test.

PATI scores of included subjects did not significantly differ between studies. Mortality was not significantly different between groups (OR 1.70; 95% CI 0.51-5.66). However, total complications (OR 0.28; 95% CI 0.18-0.42), total infectious complications (OR 0.41; 95% CI 0.27- 0.63), abdominal infections including dehiscence (OR 0.59; 95% CI 0.38-0.94), abdominal infections excluding dehiscence (OR 0.52; 95% CI 0.31-0.86), wound complications including dehiscence (OR 0.55; 95% CI 0.34-0.89), and wound complications excluding dehiscence (OR 0.43; 95% CI 0.25-0.76) all significantly favored primary repair.

Meta-analysis of currently published randomized controlled trials favors primary repair over fecal diversion for penetrating colon injuries.