C. A. Fitzgerald1, J. Broecker1, C. Park1, S. Mandell1, B. Bruns1, R. Dumas1 1University of Texas Southwestern Medical center, Dallas, TX, USA
Introduction: The management of traumatic colon injuries has evolved over the past two decades. Recent data suggests primary repair or resection over colostomy may decrease morbidity and mortality. Data comparing patients undergoing primary repair versus resection is lacking. We sought to compare the outcomes of patients undergoing primary repair versus resection for low-grade colon injuries. We hypothesized that patients undergoing primary repair would have less post-operative complications than those patients undergoing resection with anastomosis.
Methods: A retrospective review of all patients who presented with AAST grade I and II traumatic colon injury to our Level I trauma center between 2011 and 2021 was performed. Patients were further dichotomized based on whether they underwent primary repair or resection with anastomosis. Outcome measures included length of stay data, infectious complications, and mortality.
Results: A total of 120 patients met inclusion criteria. The majority of patients (76.7%) were male, and the average age was 32 [25-44.25] years. Most patients also underwent primary repair (81.1%). There were no statistically significant differences between the groups in arrival physiology. The injury severity score was similar between groups while the abdominal abbreviated injury scale was higher in the group that underwent resection with anastomosis (2.7 [2-3] vs. 3.2 [3-4], p=0.003). Length of stay data including hospital length of stay, intensive care unit length of stay, and ventilator days was similar between groups. Post-operative complications including pneumonia, surgical site infections, fascial dehiscence, the development of enterocutaneous fistulas, and unplanned returns to the operating room were also all found to be similar between groups. The group who underwent resection with anastomosis did demonstrate a higher rate of intra-abdominal abscesses (3.1% vs. 26.1%, p<0001). Mortality between both groups was not found to be statistically significant (7.2% vs. 4.3%, p=0.4)
Conclusion: For low grade (AAST I and II) traumatic colon injuries, primary repair demonstrated a decreased rate of intraabdominal abscesses and was associated with lower morbidity than resection with anastomosis.
