Primary repair for penetrating colon injuries

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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 methods We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE 1950 to Sept 2008, EMBASE 1980 to Sept 2008, ISI Web of Science: Science Citation Index Expanded (SCI‐EXPANDED) 1970 to Sept 2008, Conference Proceedings Citation Index‐Science (CPCI‐S) 1990 to Sept 2008, and PubMed (searched 26 Sept 2008). The most recent searches were carried out in September 2008. 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. Data collection and analysis Two authors independently extracted the data. Outcomes evaluated from each trial included mortality, total complications, infectious complications, intra‐abdominal infections, wound complications and penetrating abdominal trauma index (PATI). We calculated Peto odds ratios (ORs) for combined effect with a 95% confidence interval (95% CI) for each outcome. Heterogeneity was assessed for each outcome, using a chi‐squared test. Main results Six trials involving 705 patients were included. Mortality was not significantly different between groups, which was low in both the primary repair (1.94%) and the diverted groups (1.74%). The Peto OR for mortality was 1.22 (95% CI 0.40 to 3.74). However, the primary repair group experienced a significantly lower rate of complications (Peto OR 0.54; 95% CI 0.39 to 0.76), total infectious complications (Peto OR 0.44; 95% CI 0.17 to 1.1), abdominal infections including dehiscence (Peto OR 0.67; 95% CI 0.35 to 1.3), abdominal infections excluding dehiscence (Peto OR 0.69; 95% CI 0.34 to 1.39), wound complications including dehiscence (Peto OR 0.73; 95% CI 0.38 to 1.39), and wound complications excluding dehiscence (Peto OR 0.67; 95% CI 0.32 to 1.39). Statistical significance favoring primary repair over fecal diversion was achieved for all outcomes related to abdominal infections and wound complications when one study was excluded for both clinical and statistical heterogeneity in the sensitivity analysis. Authors' conclusions Meta‐analysis of currently published randomized controlled trials favors primary repair over fecal diversion for penetrating colon injuries.