Man Hon Tang, Daniel Lee. Khoo Teck Puat Hospital
Introduction: There has been more evidence to support the role of primary repair or anastomosis for colonic injuries in trauma. However, there are no randomized trials especially on blunt trauma or in cases of damage control (DC) setting.
Aims: To perform a systemic review of studies comparing outcomes of fecal diversion (FD) versus primary repair/anastomoses (PR/A) in traumatic colonic injuries.
Methods: A systematic review was performed as per PRISMA guidelines utilizing three electronic databases: Pubmed, EMBASE, and Cochrane Library resources. Primary and secondary outcomes are overall mortality and anastomotic leak rates respectively.
Results: There were 13 studies identified, including 10 retrospective, 2 prospective cohort and 1 randomised studies. Data from 1890 patients were abstracted including need for damage control surgery, surgical interventions, mortalities and complications. Overall, 71.3% of the patients underwent a PR/A, with a lesser proportion (64.5%) being performed in the DC group. The overall mortality is 3.59% (2.89% in PR/A vs 5.30% in FD). The overall anastomotic leak rate is 5.64%, and it is significantly higher in the DC group (16.7%). Most papers identified significant blood transfusion, severe abdominal contamination and physiological instability as risk factors for poor outcomes.
Conclusion: It is safe to perform PR/A in stable patients with traumatic colonic injuries. FD should be recommend in unstable patients especially in a DC setting or in those at higher risk for complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93561
Program Number: P043
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster