The researchers conducted a multicenter prospective study to compare primary anastomosis with diversion for penetrating colon injuries requiring resection, and identify the risk factors for colon-related abdominal complications.
They reported their findings in the May issue of the Journal of Trauma.
297 patients who underwent resection because of penetrating trauma, and survived at least 72 hours, were included in the study.
197 patients (66%) were managed by primary anastomosis and 100 (34%) by diversion.
Multivariate logistic regression analysis was used to compare outcomes in the patients and identify independent risk factors for the development of abdominal complications.
The overall colon-related mortality was 1.3% (four deaths in the diversion group, no deaths in the primary anastomosis group).
Colon-related abdominal complications occurred in 24% of all patients (primary repair, 22%; diversion, 27%).
Primary anastomosis should be considered in all such patients.
|Dr Demetrios Demetriades|
Multivariate analysis identified three independent risk factors for abdominal complications: severe fecal contamination; transfusion of greater than 4 units of blood within the first 24 hours; and single-agent antibiotic prophylaxis.
The type of colon management was not found to be a risk factor.
Comparison of primary anastomosis with diversion using multivariate analysis adjusting for risk factors showed no statistically significant difference in outcome.
Similarly, multivariate analysis and comparison of the two methods of colon management in high-risk patients showed no difference in outcome.
Dr Demetrios Demetriades, of the Los Angeles County and University of Southern California Trauma Center, said on behalf of colleagues, "The surgical method of colon management after resection for penetrating trauma does not affect the incidence of abdominal complications, irrespective of associated risk factors."
"In view of these findings, the reduced quality of life, and the need for a subsequent operation in colostomy patients, primary anastomosis should be considered in all such patients," it was concluded.