title: Applicability of an established management algorithm for destructive colon injuries after abbreviated laparotomy: a 17-year experience.
abstract: BACKGROUND
  For more than a decade, operative decisions (resection plus anastomosis vs diversion) for colon injuries, at our institution, have followed a defined management algorithm based on established risk factors (pre- or intraoperative transfusion requirements of more than 6 units packed RBCs and/or presence of significant comorbid diseases). However, this management algorithm was originally developed for patients managed with a single laparotomy. The purpose of this study was to evaluate the applicability of this algorithm to destructive colon injuries after abbreviated laparotomy (AL) and to determine whether additional risk factors should be considered.
  
  
  METHODS
  Consecutive patients over a 17-year period with colon injuries after AL were identified. Nondestructive injuries were managed with primary repair. Destructive wounds were resected at the initial laparotomy followed by either a staged diversion (SD) or a delayed anastomosis (DA) at the subsequent exploration. Outcomes were evaluated to identify additional risk factors in the setting of AL.
  
  
  RESULTS
  We identified 149 patients: 33 (22%) patients underwent primary repair at initial exploration, 42 (28%) underwent DA, and 72 (49%) had SD. Two (1%) patients died before re-exploration. Of those undergoing DA, 23 (55%) patients were managed according to the algorithm and 19 (45%) were not. Adherence to the algorithm resulted in lower rates of suture line failure (4% vs 32%, p = 0.03) and colon-related morbidity (22% vs 58%, p = 0.03) for patients undergoing DA. No additional specific risk factors for suture line failure after DA were identified.
  
  
  CONCLUSIONS
  Adherence to an established algorithm, originally defined for destructive colon injuries after single laparotomy, is likewise efficacious for the management of these injuries in the setting of AL.
authors: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors: John P
authors: JP
authors: Sharpe
authors: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN. Electronic address: lmagnott@uthsc.edu.
authors: Louis J
authors: LJ
authors: Magnotti
authors: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors: Jordan A
authors: JA
authors: Weinberg
authors: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors: Charles P
authors: CP
authors: Shahan
authors: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors: Darren R
authors: DR
authors: Cullinan
authors: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors: Katy A
authors: KA
authors: Marino
authors: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors: Timothy C
authors: TC
authors: Fabian
authors: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors: Martin A
authors: MA
authors: Croce
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000465:Algorithms; D000714:Anastomosis, Surgical; D003082:Colectomy; D003106:Colon / Q000293:injuries* / Q000601:surgery; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods*; D008297:Male; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery