Meta-analysis on surgical management of colonic injuries in trauma: to divert or to anastomose?
BACKGROUND
Primary repair or resection with anastomosis (PR/A) has been gaining increasing recognition for traumatic colonic injuries, with the need for faecal diversion (FD) especially those of penetrating etiology being questioned. However, the role of PR/A in critically ill patients is still controversial with concerns pertaining to safety and anastomotic leak.


AIMS AND METHODS
We performed a systemic review of studies comparing outcomes of FD versus PR/A in traumatic colonic injuries. A systematic review was performed as per PRISMA guidelines utilizing three electronic databases: Pubmed, EMBASE, and Cochrane Library resources. Mortality and anastomotic leak rates are identified as the primary and secondary outcomes, respectively. Data extracted include mortality rates, type of surgical intervention, surgical complications, and need for DC (damage control) surgery.


RESULTS
Fourteen studies were identified comprising 11 retrospective, 2 prospective cohort and 1 randomized trial with a total of 2071 patients. Six studies included patients that underwent DC surgery. The overall mortality rate was 3.77% and was higher in the FD group compared to PR/A group (5.38% vs 2.49%, p = 0.07). 71.3% of patients underwent PR/A with an overall leak rate of 4.63%. There was no difference in intra-abdominal collections between the PR/A and FD groups. In the subgroup analysis, anastomotic leak rate was significantly higher in the DC group compared to non-DC group (16.7% vs 3.2%, p = 0.003).


CONCLUSIONS
This meta-analysis supports PR/A in stable patients with traumatic colonic injuries. FD should be considered in critically ill patients who require DC surgery as leak rates are significantly higher.
['Tang|Man Hon|MH|http://orcid.org/0000-0003-2762-5580', 'Wong|Joel Shi Hao|JSH|', 'Chia|Clement Luck Khng|CLK|', 'Lee|Daniel Jin Keat|DJK|']
D000714:Anastomosis, Surgical D057868:Anastomotic Leak D003106:Colon D006801:Humans D011446:Prospective Studies D016032:Randomized Controlled Trials as Topic D012189:Retrospective Studies
Colon injury Trauma Anastomotic leak Stoma