Complications of primary repair of colon injury: literature review of 2,964 cases.
OBJECTIVE
To evaluate the safety and efficacy of primary repair of colon injuries.


METHODS
A literature review was made of 35 publications containing 5,400 colon injuries in retrospective and prospective studies.


RESULTS
There were 62 (2.4%) failures in 2,627 primary repairs based on surgeon discretion or absence of risk factors. In prospective series of 337 patients repaired without exclusionary criteria, there were 4 (1.2%) suture line failures (P = not significant). In prospective randomized trials without exclusionary criteria, 127 primary repairs had less morbidity compared with 109 diverted patients (P <0.02). The leak rate after resection and anastomosis (5.5%) is greater than after simple suture of perforation (1.4%; P <0.001). The 66 colon repair leaks were treated by conversion to colostomy or led to fistulae that usually healed spontaneously. A preponderance of failed repairs occurred in the setting of multiple injuries or comorbid conditions.


CONCLUSIONS
Penetrating and blunt colon injuries in civilian practice are safely managed by primary repair, but colostomy may still be advised in selected cases.
Legacy Emanuel Hospital and the Department of Surgery, Oregon Health Sciences University, Portland, USA.
T J
TJ
Curran
A P
AP
Borzotta
D000714:Anastomosis, Surgical; D003106:Colon / Q000293:injuries* / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013536:Suture Techniques; D016896:Treatment Outcome