Canadian Association of General Surgeons evidence based reviews in surgery. 12. Primary repair for penetrating colon injuries.

Objective: To determine if the treatment of penetrating colonic injury must include fecal diversion at or proximal to the injury, to avoid sepsis and mortality. Data source: Studies were identified by searching MEDLINE 1966–2001, the Cochrane Controlled Trials Registry and EMBASE. Study selection: Studies were included if they were randomized controlled trials comparing outcomes of primary repair versus fecal diversion in the management of penetrating colon injuries; 5 studies were identified. Outcome measures: Operative mortality, total complications, total infectious complications, intraabdominal infections, abdominal infections excluding dehiscence, and wound complications including and excluding dehiscence. Penetrating abdominal trauma index (PATI) and length of stay were included when available. Results: PATI did not significantly differ between groups; neither did mortality (odds ratio [OR] 1.7, 95% confidence interval [CI] 0.51–5.66). However, total complications (OR 0.28, CI 0.18–0.42), total infectious complications (OR 0.41, CI 0.27–0.63), intra-abdominal infections (OR 0.59, CI 0.38– 0.94), abdominal infections excluding dehiscence (OR 0.52, CI 0.31– 0.86) and wound complications including (OR 0.55, CI 0.34–0.89) and excluding dehiscence (OR 0.43, CI 0.25–0.76) all significantly favoured primary repair. Conclusions: Primary repair of penetrating colon injuries is as safe as fecal diversion and has a lower complication rate.