Reevaluating Delayed Anastomosis for Traumatic Colon Injuries in Damage Control Laparotomy

BackgroundDuring damage control laparotomy (DCL), colonic anastomoses are often deferred to subsequent operations in patients undergoing colonic resections. However, the impact of delayed anastomosis on patient outcomes has not been widely studied. We aimed to analyze the incidence of anastomosis-related complications between immediate and delayed colonic anastomosis patients a retrospective study at a Level 1 trauma center including patients with temporary abdominal closure (TAC). Complications of patients who underwent immediate anastomosis were compared to those in subsequent operations to evaluate the association between the timing of anastomosis in DCL and outcomes.MethodsWe conducted (2016-2023) retrospective chart review to analyze outcomes of patients who underwent DCL, TAC, and colonic anastomosis either during the index operation or takeback.ResultsOf the 94 patients identified, 65 underwent immediate and 29 underwent delayed anastomosis. Blunt trauma patients were more likely to undergo delayed anastomosis, while penetrating trauma patients were more likely to undergo immediate anastomosis (52% vs 78%, P < .01). The time to second-look operation did not differ significantly between immediate and DCL group. Univariable logistic anastomosis and patient delayed groups (36 vs 29 h, P = .09). The rate of anastomotic leak was comparable between groups (immediate: 14%, delayed: 10%; odds ratio [OR]:1.45, 95% confidence interval [CI]:0.35-6.07, P = .64). There was no significant difference in in-hospital mortality between the study groups (OR: 1.57, 95% CI: 0.46-5.36, P = .54).ConclusionImmediate colonic anastomosis during DCL was not associated with increased risk of anastomotic leak or in-hospital mortality.