Related Experiment Videos
A convincing case for primary repair of penetrating colon injuries
P A Taheri1, J J Ferrara, C E Johnson
1Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112.
Insights
Primary repair of colon injuries is safer than diverting colostomy, showing fewer wound infections and lower mortality. Both methods have similar rates of major intra-abdominal complications.
Area of Science:
- Trauma Surgery
- Colorectal Surgery
- Surgical Outcomes
Background:
- Penetrating colon trauma presents significant management challenges.
- Surgical options include primary repair (PR) or diverting colostomy (DC).
- Comparing outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To compare the safety and efficacy of primary repair versus diverting colostomy for penetrating colon injuries.
- To analyze rates of intra-abdominal complications, wound infections, and mortality.
Main Methods:
- Retrospective analysis of 146 patients with penetrating colon trauma.
- Comparison of outcomes between patients managed with PR (n=55) and DC (n=91).
- Assessment of demographic data, injury severity scores, and complication rates.
Main Results:
- No significant differences in intra-abdominal complications (PR 12.7% vs. DC 11%).
- Wound infection rates were significantly higher in the PR group (19.6%) compared to the DC group (9.4%).
- Mortality was 0% for PR and 3.6% for DC. Elective colostomy closure had a 9.1% intra-abdominal complication rate.
Conclusions:
- Primary repair of colon injuries is associated with lower wound infection rates and no mortality.
- Diverting colostomy carries a mortality risk and risks associated with subsequent closure.
- Data support primary repair for most colon injuries, reserving colostomy for select cases with extensive damage.
Abstract:
Over the past 14 years, 146 patients with penetrating colon trauma were managed by primary repair with/without resection (PR, n = 55), and by diverting colostomy (DC, n = 91). These groups did not differ in terms of age, ISS (Injury Severity Scale), PATI (Penetrating Abdominal Trauma Index), a-AIS (abdominal Abbreviated Injury Scale), or preoperative hypotension. No intergroup differences were manifested in intra-abdominal complications (fistula/leak, abscess, pancreatitis, intestinal obstruction, wound dehiscence). The percentage of patients who experienced at least one major intra-abdominal complication did not differ statistically when the two groups were compared--12.7% in PR versus 11% in DC--although risk in both groups increased with the additional number of organs injured. Wound infection was significantly higher (p < 0.05) in the PR group (19.6%) compared with the DC group (9.4%). Mortality in the PR and DC groups was 0% and 3.6%, respectively. One hundred and ten patients who underwent elective colostomy closure following trauma had a 9.1% intra-abdominal complication rate and a 3.6% wound infection rate. These risks should be considered when colostomy is selected to manage patients with penetrating colon injury. These data support primary repair of all colon injuries, reserving skin closure for patients with limited collateral damage.