R Nelson1, M Singer. 1. Department of Surgery, University of Illinois Hospital, 1740 W. Taylor, Room 2004, Chicago, Illinois 60612, USA.
Abstract
BACKGROUND: Primary repair of penetrating colon injuries is an appealing management option. However, uncertainty about its safety persists. OBJECTIVES: The objective of this review was to compare morbidity and mortality rates after primary repair to the rates after fecal diversion, in the management of penetrating colon injuries, using a meta-analysis of randomized controlled trials. SEARCH STRATEGY: We searched MEDLINE (1966 to November 2001), the Cochrane Controlled Trials Register, and EMBASE using the terms colon, penetrating, injury, colostomy, prospective, and randomized. SELECTION CRITERIA: Studies were included if they were randomized controlled trials comparing the outcomes of primary repair versus fecal diversion in the management of penetrating colon injuries. Five studies were included. DATA COLLECTION AND ANALYSIS: Reviewers performed data extraction independently. Outcomes evaluated from each trial included mortality, total complications, infectious complications, intra-abdominal infections, wound complications, penetrating abdominal trauma index (PATI), and length of stay. Peto odds ratios (ORs) for combined effect were calculated with a 95% confidence interval (95% CI) for each outcome. Heterogeneity was assessed for each outcome, using a chi-squared test. MAIN RESULTS: PATI scores of included subjects did not significantly differ between studies. Mortality was not significantly different between groups (OR 1.70; 95% CI 0.51-5.66). However, total complications (OR 0.28; 95% CI 0.18-0.42), total infectious complications (OR 0.41; 95% CI 0.27- 0.63), abdominal infections including dehiscence (OR 0.59; 95% CI 0.38-0.94), abdominal infections excluding dehiscence (OR 0.52; 95% CI 0.31-0.86), wound complications including dehiscence (OR 0.55; 95% CI 0.34-0.89), and wound complications excluding dehiscence (OR 0.43; 95% CI 0.25-0.76) all significantly favored primary repair. REVIEWER'S CONCLUSIONS: Meta-analysis of currently published randomized controlled trials favors primary repair over fecal diversion for penetrating colon injuries.
BACKGROUND: Primary repair of penetrating colon injuries is an appealing management option. However, uncertainty about its safety persists. OBJECTIVES: The objective of this review was to compare morbidity and mortality rates after primary repair to the rates after fecal diversion, in the management of penetrating colon injuries, using a meta-analysis of randomized controlled trials. SEARCH STRATEGY: We searched MEDLINE (1966 to November 2001), the Cochrane Controlled Trials Register, and EMBASE using the terms colon, penetrating, injury, colostomy, prospective, and randomized. SELECTION CRITERIA: Studies were included if they were randomized controlled trials comparing the outcomes of primary repair versus fecal diversion in the management of penetrating colon injuries. Five studies were included. DATA COLLECTION AND ANALYSIS: Reviewers performed data extraction independently. Outcomes evaluated from each trial included mortality, total complications, infectious complications, intra-abdominal infections, wound complications, penetrating abdominal trauma index (PATI), and length of stay. Peto odds ratios (ORs) for combined effect were calculated with a 95% confidence interval (95% CI) for each outcome. Heterogeneity was assessed for each outcome, using a chi-squared test. MAIN RESULTS: PATI scores of included subjects did not significantly differ between studies. Mortality was not significantly different between groups (OR 1.70; 95% CI 0.51-5.66). However, total complications (OR 0.28; 95% CI 0.18-0.42), total infectious complications (OR 0.41; 95% CI 0.27- 0.63), abdominal infections including dehiscence (OR 0.59; 95% CI 0.38-0.94), abdominal infections excluding dehiscence (OR 0.52; 95% CI 0.31-0.86), wound complications including dehiscence (OR 0.55; 95% CI 0.34-0.89), and wound complications excluding dehiscence (OR 0.43; 95% CI 0.25-0.76) all significantly favored primary repair. REVIEWER'S CONCLUSIONS: Meta-analysis of currently published randomized controlled trials favors primary repair over fecal diversion for penetrating colon injuries.
Authors: Carlos A Ordoñez; Michael W Parra; Yaset Caicedo; Natalia Padilla; Edison Angamarca; José Julián Serna; Fernando Rodríguez-Holguín; Alberto García; Alexander Salcedo; Luis Fernando Pino; Adolfo González-Hadad; Mario Alain Herrera; Laureano Quintero; Fabian Hernández; María Josefa Franco; Gonzalo Aristizábal; Luis Eduardo Toro; Mónica Guzmán-Rodríguez; Federico Coccolini; Ricardo Ferrada; Rao Ivatury Journal: Colomb Med (Cali) Date: 2021-04-27