Primary repair for penetrating colon injuries.
BACKGROUND
Primary repair of penetrating colon injuries is an appealing management option, however uncertainty about its safety persists.


OBJECTIVE
The objective of this review was to compare the morbidity and mortality of primary repair to fecal diversion in the management of penetrating colon injuries using a meta-analysis of randomized controlled trials.


METHODS
We searched MEDLINE (1966 to November 2001), the Cochrane Controlled Trials Register, and EMBASE using the terms colon, penetrating, injury, colostomy, prospective, and randomized.


METHODS
Studies were included if they were randomized controlled trials comparing the outcomes of primary repair versus fecal diversion in the management of penetrating colon injuries. Five studies were included.


METHODS
Reviewers performed data extraction independently. Outcomes evaluated from each trial included mortality, total complications, infectious complications, intra-abdominal infections, wound complications, penetrating abdominal trauma index (PATI), and length of stay. Peto odds ratios for combined effect were calculated with a 95% confidence interval for each outcome. Heterogeneity was assessed for each outcome using a chi-squared test.


RESULTS
The Penetrating Abdominal Trauma Index (PATI) of included subjects did not significantly differ between studies. Mortality was not significantly different between groups (OR 1.70, 95% CI 0.51,5.66). However, total complications (OR 0.28 95% CI 0.18,0.42), total infectious complications (OR 0.41, 95% CI 0.27, 0.63), abdominal infections including dehiscence (OR 0.59, 95% CI 0.38,0.94), abdominal infections excluding dehiscence (OR 0.52 95% CI 0.31,0.86), wound complications including dehiscence (OR 0.55, 95% CI 0.34,0.89), and wound complications excluding dehiscence (OR 0.43, 95% CI 0.25,0.76) all significantly favored primary repair.


CONCLUSIONS
Meta-analysis of currently published randomized controlled trials favors primary repair over fecal diversion for penetrating colon injuries.
Nelson
R
R
Department of Surgery, University of Illinois Hospital, 1740 W. Taylor, Room 2004, Chicago, Illinois 60612, USA. altohorn@uic.edu
Singer
M
M
D003106:Colon / Q000293:injuries*; D006801:Humans; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D014950:Wounds, Penetrating / Q000601:surgery*