title: Discontinuity of the Bowel Following Damage Control Operation Revisited: A Multi-institutional Study.
abstract: Discontinuity of the bowel following intestinal injury and resection is a common practice in damage control procedures for severe abdominal trauma. However, there are concerns that complete occlusion of the bowel, especially in the presence of hypotension or edema that may result in ischemic bowel changes or increase bacterial or toxin translocation.
  
  
  
  This was a retrospective study from three Level-1 trauma centers. Included were trauma patients who required bowel resection and damage control. The study population was stratified into two groups based on the management for bowel injury: bowel discontinuity versus primary anastomosis. Outcomes included anastomotic leak, organ space infection, bowel ischemia, and mortality.
  
  
  
  A total of 167 cases were included. In 84 cases, continuity of the bowel was established, and in 83, the bowel was left in discontinuity. The epidemiological, admission, and intraoperative physiological characteristics, the abdominal Abbreviated Injury Scale, type of intra-abdominal injury, and transfusion requirements were similar in the two study groups. The mortality was 8.3 % in the continuity group and 16.9 % for the discontinuity group (p = 0.096). On the crude bivariate and adjusted regression analyses, there was a higher rate of bowel ischemia at the take-back operation in the discontinuity group (p = 0.003 for the crude and p = 0.034 for the adjusted). The organ space infection and anastomotic leak rate were not significantly different between the study groups.
  
  
  
  Discontinuity of the bowel following damage control operation is associated with a higher risk of bowel ischemia than in patients with anastomosis. Further prospective observational and randomized studies are warranted.
  
  
  
  III.
authors.affiliation: Division of Acute Care Surgery Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, IPT-C5L100, 2051 Marengo Str. 90033, Los Angeles, CA, USA.
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.affiliation: Division of Acute Care Surgery Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, IPT-C5L100, 2051 Marengo Str. 90033, Los Angeles, CA, USA.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Chouliaras
authors.affiliation: Division of Burn/Trauma/Critical Care at UT Southwestern Medical Center, The Trauma Center at Parkland, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Eastman
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Lauerman
authors.affiliation: Division of Acute Care Surgery Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, IPT-C5L100, 2051 Marengo Str. 90033, Los Angeles, CA, USA.
authors.forename: Pedro G
authors.initials: PG
authors.lastname: Teixeira
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: DuBose
authors.affiliation: Division of Burn/Trauma/Critical Care at UT Southwestern Medical Center, The Trauma Center at Parkland, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Minei
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Scalea
authors.affiliation: Division of Acute Care Surgery Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, IPT-C5L100, 2051 Marengo Str. 90033, Los Angeles, CA, USA. demetria@usc.edu.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007422:Intestines / Q000098:blood supply / Q000293:injuries* / Q000601:surgery*; D007511:Ischemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome