Meta-analysis on surgical management of colonic injuries in trauma: to divert or to anastomose?

Tang, Man Hon; Wong, Jonathan; Chia, Clement Luck Khng; Lee, Dong Hoon

doi:10.1007/s00068-020-01555-2

Cited by 8 publications

(5 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our power calculation was based on effect sizes derived from a recently conducted study which showed the percentage of the overall AL to be near 16%. 6 According to these preliminary data, the AL in BHIs is high. Therefore, the number of subjects needed for each group is 1447.…”

Section: Sample Size Justificationmentioning

confidence: 90%

Rates and risk factors for anastomotic leak following blunt trauma-associated bucket handle intestinal injuries: a multicenter study

Grossman,

Dhanasekara,

Shrestha

et al. 2023

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

ObjectivesThe risk factors for anastomotic leak (AL) after resection and primary anastomosis for traumatic bucket handle injury (BHI) have not been previously defined. This multicenter study was conducted to address this knowledge gap.MethodsThis is a multicenter retrospective study on small intestine and colonic BHIs from blunt trauma between 2010 and 2021. Baseline patient characteristics, risk factors, presence of shock and transfusion, operative details, and clinical outcomes were compared using R.ResultsData on 395 subjects were submitted by 12 trauma centers, of whom 33 (8.1%) patients developed AL. Baseline details were similar, except for a higher proportion of patients in the AL group who had medical comorbidities such as diabetes, hypertension, and obesity (60.6% vs. 37.3%, p=0.015). AL had higher rates of surgical site infections (13.4% vs. 5.3%, p=0.004) and organ space infections (65.2% vs. 11.7%, p<0.001), along with higher readmission and reoperation rates (48.4% vs. 9.1%, p<0.001, and 39.4% vs. 11.6%, p<0.001, respectively). There was no difference in intensive care unit length of stay or mortality (p>0.05). More patients with AL were discharged with an ostomy (69.7% vs. 7.3%, p<0.001), and the mean duration until ostomy reversal was 5.85±3 months (range 2–12.4 months). The risk of AL significantly increased when the initial operation was a damage control procedure, after adjusting for age, sex, injury severity, presence of one or more comorbidities, shock, transfusion of >6 units of packed red blood cells, and site of injury (adjusted RR=2.32 (1.13, 5.17)), none of which were independent risk factors in themselves.ConclusionDamage control surgery performed as the initial operation appears to double the risk of AL after intestinal BHI, even after controlling for other markers of injury severity.Level of evidenceIII.

show abstract

Section: Sample Size Justificationmentioning

confidence: 90%

Rates and risk factors for anastomotic leak following blunt trauma-associated bucket handle intestinal injuries: a multicenter study

Grossman,

Dhanasekara,

Shrestha

et al. 2023

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

show abstract

“…The employment of DCL has increased over the past few decades and offers a tantalizing option to reevaluate the injured colon in a later controlled environment 18–20 . Damage-control laparotomy in the setting of destructive colon trauma offers three options, all protected by the possibility of a prompt second look.…”

Section: Discussionmentioning

confidence: 99%

“…The employment of DCL has increased over the past few decades and offers a tantalizing option to reevaluate the injured colon in a later controlled environment. [18][19][20] Damage-control laparotomy in the setting of destructive colon trauma offers three options, all protected by the possibility of a prompt second look. The first option is definitive management of colectomy and anastomosis with an evaluation of the repair at the next surgery; a second option is initial resection followed by anastomosis at the later laparotomy.…”

Section: Discussionmentioning

confidence: 99%

Operative management and outcomes of colorectal injuries after gunshot wounds in the deployed military setting versus civilian trauma centers

Dilday,

Owattanapanich,

Benjamin

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

INTRODUCTION Colon and rectal injuries have been diverted at higher rates in military trauma compared with civilian injuries. However, in the last few years, there has been a shift to more liberal primary anastomosis in wartime injuries. The purpose of this study was to compare the management and outcomes in colorectal gunshot wounds (GSWs) between military and civilian settings. METHODS The study included Department of Defense Trauma Registry and Trauma Quality Improvement Program database patients who sustained colorectal GSWs, during the period 2013 to 2016. Department of Defense Trauma Registry patients were propensity score matched 1:3 based on age, sex, grade of colorectal injury, and extra-abdominal Abbreviated Injury Scale. Patients without signs of life, transfers from an outside hospital, and nonspecific colorectal Organ Injury Scale were excluded. Operative management and outcomes were compared between the two groups. Subanalysis was performed on the military cohort to identify any differences in the use primary repair, colectomy, or fecal diversion based upon military affiliation or North Atlantic Treaty Organization status. RESULTS Overall, there were 2,693 patients with colorectal GSWs; 60 patients in the military group were propensity score matched with 180 patients in the civilian group. Overall, colectomy was the most common procedure performed (72.1%) and was used more frequently in the military group (83.3% vs. 68.3%; p < 0.05). However, the rate of fecal diversion was similar in the two groups (23.3% vs. 27.8%; p = 0.500). Among those in the military group, no difference was seen in primary repair, colectomy, or fecal diversion based upon military affiliation or North Atlantic Treaty Organization status. The rates of in-hospital compilations and mortality were similar between the military and civilian groups. CONCLUSION The severity of GSW colorectal injuries in military and civilian trauma was comparable. There was no significant difference in terms of fecal diversion, mortality, and complications between groups. Military personnel are treated similarly regardless of affiliation. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.

show abstract

“…4 28 The more nuanced approach is supported by a recent metaanalysis that recommends primary repair or resection with anastomosis in colon trauma unless patients are critically unwell or undergoing damage control surgery (DCS) as these patients have a significantly higher rate of anastomotic leak. 29 Given all the injuries in our data set were low-energy wounds from sharp objects and all extraperitoneal injuries, it is perhaps surprising that half of these injuries were managed with fecal diversion. Two (33.34%) of these patients were recognized to have a potentially destructive extraperitoneal injury during EUA and so were appropriately managed with a defunctioning…”

Section: Management Of Colorectal Traumamentioning

confidence: 99%

“…Results There were 125 presentations with PGI, accounting for 6.86% of all penetrating injuries. Of these, 95.2% (119) were male, with a median age of [21][22][23][24][25][26][27][28][29], and 20.80% (26) were under 18. Compared with the 3 years prior to this study, the number of PGI increased by 87%.…”

mentioning

confidence: 99%

Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline

McKnight

Yalamanchili

Sanchez-Thompson

et al. 2021

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

BackgroundPenetrating gluteal injuries (PGIs) are an increasingly common presentation to major trauma centers (MTCs) in the UK and especially in London. PGIs can be associated with mortality and significant morbidity. There is a paucity of consistent guidance on how best to investigate and manage these patients.MethodsA retrospective cohort study was performed by interrogating prospectively collected patient records for PGI presenting to a level 1 MTC in London between 2017 and 2019.ResultsThere were 125 presentations with PGI, accounting for 6.86% of all penetrating injuries. Of these, 95.2% (119) were male, with a median age of 21 (IQR 18–29), and 20.80% (26) were under 18. Compared with the 3 years prior to this study, the number of PGI increased by 87%. The absolute risk (AR) of injury to a significant structure was 27.20%; the most frequently injured structure was a blood vessel (17.60%), followed by the rectum (4.80%) and the urethra (1.60%). The AR by anatomic quadrant of injury was highest in the lower inner quadrant (56%) and lowest in the upper outer quadrant (14%). CT scanning had an overall sensitivity of 50% and specificity of 92.38% in identifying rectal injury.DiscussionThe anatomic quadrant of injury can be helpful in stratifying risk of rectal and urethral injuries when assessing a patient in the emergency department. Given the low sensitivity in identifying rectal injury on initial CT, this data supports assesing any patients considered at high risk of rectal injury with an examination under general anesthetic with or without rigid sigmoidoscopy . The pathway has created a clear tool that optimizes investigation and treatment, minimizing the likelihood of missed injury or unnecessary use of resources. It therefore represents a potential pathway other centers receiving a similar trauma burden could consider adopting.Level of evidence2b.

show abstract

Meta-analysis on surgical management of colonic injuries in trauma: to divert or to anastomose?

Cited by 8 publications

References 29 publications

Rates and risk factors for anastomotic leak following blunt trauma-associated bucket handle intestinal injuries: a multicenter study

Rates and risk factors for anastomotic leak following blunt trauma-associated bucket handle intestinal injuries: a multicenter study

Operative management and outcomes of colorectal injuries after gunshot wounds in the deployed military setting versus civilian trauma centers

Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline

Contact Info

Product

Resources

About