Primary Repair Versus Resection for AAST Grade I and II Colon Injuries: Does the Type of Repair Matter?

• Published in: The Journal of surgical research Vol. 295; pp. 370 - 375
• Main Authors: Fitzgerald, Caitlin A., Broecker, Justine, Park, Caroline, Dumas, Ryan P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024
• Subjects: Abdominal Abscess - surgery; Abdominal Injuries - surgery; Adult; Colectomy; Colon - injuries; Colon - surgery; Colonic Diseases - surgery; Colostomy - adverse effects; Female; Humans; Male; Middle Aged; Primary repair; Resection; Retrospective Studies; Thoracic Injuries - surgery; Trauma; Treatment Outcome; Wounds, Penetrating - surgery; Young Adult; Primary repair; Colon injuries; Resection; Trauma
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2023.11.023

The management of traumatic colon injuries has evolved over the past two decades. Recent evidence suggests that primary repair or resection over colostomy may decrease morbidity and mortality. Data comparing patients undergoing primary repair versus resection are lacking. We sought to compare the outcomes of patients undergoing primary repair versus resection for low-grade colon injuries. A retrospective review of all patients who presented with American Association for the Surgery of Trauma grade I and II traumatic colon injuries to our Level I trauma center between 2011 and 2021 was performed. Patients were further dichotomized based on whether they underwent primary repair or resection with anastomosis. Outcome measures included length of stay data, infectious complications, and mortality. A total of 120 patients met inclusion criteria. The majority of patients (76.7%) were male, and the average age was 35.6 ± 13.1 y. Most patients also underwent primary repair (80.8%). There were no statistically significant differences between the groups in arrival physiology or in injury severity score. Length of stay data including hospital length of stay, intensive care unit length of stay, and ventilator days were similar between groups. Postoperative complications including pneumonia, surgical site infections, fascial dehiscence, the development of enterocutaneous fistulas, and unplanned returns to the operating room were also all found to be similar between groups. The group who underwent resection with anastomosis did demonstrate a higher rate of intra-abdominal abscess development (3.1% versus 26.1%, P < 0001). Mortality between both groups was not found to be statistically significant (7.2% versus 4.3%, P = 0.4) For low-grade (American Association for the Surgery of Trauma I and II) traumatic colon injuries, patients undergoing primary repair demonstrated a decreased rate of intra-abdominal abscess development when compared to patients who underwent resection with anastomosis.