Reevaluating Delayed Anastomosis for Traumatic Colon Injuries in Damage Control Laparotomy

Area of Science:

• Trauma Surgery
• Surgical Outcomes
• Colorectal Surgery

Background:

• Colonic anastomoses are often deferred during damage control laparotomy (DCL).
• The impact of delayed anastomosis on patient outcomes remains understudied.
• Temporary abdominal closure (TAC) is frequently used in DCL patients.

Purpose of the Study:

• To compare anastomosis-related complications between immediate and delayed colonic anastomosis in DCL patients.
• To evaluate the association between the timing of colonic anastomosis and patient outcomes.
• To analyze outcomes in trauma patients undergoing DCL with TAC.

Main Methods:

• Retrospective chart review (2016-2023) at a Level 1 trauma center.
• Inclusion of patients undergoing DCL, TAC, and colonic anastomosis (immediate or delayed).
• Comparison of complication rates and in-hospital mortality between immediate and delayed anastomosis groups.

Main Results:

• 94 patients identified: 65 immediate anastomosis, 29 delayed.
• Blunt trauma more likely delayed; penetrating trauma more likely immediate anastomosis (P < .01).
• Comparable rates of anastomotic leak (14% vs 10%) and in-hospital mortality between groups (OR 1.57, P = .54).

Conclusions:

• Immediate colonic anastomosis during DCL is not associated with increased anastomotic leak risk.
• Immediate colonic anastomosis during DCL does not increase in-hospital mortality.
• Timing of colonic anastomosis in DCL does not significantly impact major adverse outcomes.