Evolution of the treatment of the injured colon in the 1980s
J. M. Burch, R. R. Martin, R. J. Richardson, D. S. Muldowny, K. L. Mattox and G. L. Jordan Jr
Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, TX 77030.
During the past 10 years, 1006 patients with colon injuries were treated in
an urban trauma center. Primary repair, including suture repair and
resection with anastomosis, was performed in 614 patients (61%), colostomy
in 284 patients (28%), and exteriorized repairs in 83 patients (8.3%). In
the remaining 25 patients (2.5%) who were exsanguinating, the colon
injuries were ligated. Independent risk factors for adverse outcomes
(defined as a fecal fistula, abdominal abscess, stomal complication, or
death from multisystem failure) were identified using multiple logistic
regression analysis. These factors were used to match patients at similar
risk within different treatment groups, and odds ratios for each treatment
were calculated. The odds ratios for primary repair, colostomy, and
exteriorized repair were 1.0, 1.9, and 2.0, respectively. Therefore, the
chance of an adverse outcome was twice as great for both exteriorized
repair or colostomy as for primary repair. It is concluded that further
increases in the use of primary repair are warranted.
