COLON DIVERSION VS. DELAYED COLON ANASTOMOSIS REPAIR OUTCOME IN TRAUMATIC COLON INJURIES AFTER DAMAGE CONTROL LAPAROTOMY
V Cabrera Bou, P Kondylis, S Gray
University of Central Florida/HCA: Greater Orlando
Over the last fifty years, controversy has persisted regarding the ideal approach to colon reconstruction after damage control laparotomy (DCL) for significant colon injuries. The most commonly employed techniques include immediate reconstruction with proximal diversion (PD) and stoma creation with deferred closure (DC) for colonic reconstitution. The purpose of this study is to evaluate these two major colonic operative strategies.
We performed a retrospective cohort review from the prospectively accrued, deidentified HCA Enterprise Level Clinical Database for patients with destructive colon injuries undergoing PD or DC during 2014-2019. Analysis included comparison of comorbidities, complications and clinical outcomes. The regression models controlled for age, gender, race, and comorbidities (splenic injury, hepatic injury, acute renal injury, chronic renal dysfunction, and pancreatic injury). Exclusion criteria include trauma patients that did not survive to undergo return to the OR. Pediatric ( < 18 years of age) patients were excluded as were those undergoing damage control laparotomy for non-traumatic indications.
Five thousand four hundred ninety-seven adult patients having undergone trauma DCL with a destructive colon injury were identified. This included both penetrating and blunt abdominal injury etiologies. PD and DC accounted for 3,979 and 1,518 patients respectively. Gender distribution in PD and DC among man to female accounted 1:1.5 ratio and 1:1 ratio, respectively. When comparing complications among PD and DC, retroperitoneal abscess (3.23% vs 1.23%, odds ratio 2.6), anastomotic leaks (11.26% vs. 5.03%, odds ratio 1.87), colostomy complications (1.05% vs. 0.08%, odds ratio 11.287) and fistula formation (1.91% vs. 0.75%, odds ratio 2.6) were more common in the DC group. There was no significant difference in 90-day mortality. ICU length of stay and overall hospital length of stay were significantly longer for DC relative to PD (mean of 7.4 vs. 5.2 days and 15.83 vs 10.59 days respectively).
This series is one of the largest reported on this topic. PD after DCL in stabilized trauma patients is safe, associated with fewer complications, and a shorter length of stay. Future consideration should be given to defining the clinical criteria within which proximal diversion can be omitted in these patients.
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