Management of penetrating intra-peritoneal colon injuries: A meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma

Background The management of penetrating colon injuries in civilians has evolved over the last four decades. The objectives of this meta-analysis are to evaluate the current treatment regimens available for penetrating colon injuries and assess the role of anastomosis in damage control surgery to develop a practice management guideline for surgeons. Methods Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, a subcommittee of the Practice Management Guidelines section of EAST conducted a systematic review using MEDLINE and EMBASE articles from 1980 through 2017. We developed three relevant problem, intervention, comparison, and outcome (PICO) questions regarding penetrating colon injuries. Outcomes of interest included mortality and infectious abdominal complications. Results Thirty-seven studies were identified for analysis, of which 16 met criteria for quantitative meta-analysis and included 705 patients considered low-risk in six prospective randomized studies. Seven hundred thirty-eight patients in 10 studies undergoing damage control laparotomy (DCL) and repair or resection and anastomosis (R&A) were included in a separate meta-analysis. Meta-analysis of high-risk patients undergoing repair or R&A was not feasible due to inadequate data. Conclusions In adult civilian patients sustaining penetrating colon injury without signs of shock, significant hemorrhage, severe contamination, or delay to surgical intervention, we recommend that colon repair or R&A be performed rather than routine colostomy. In adult high-risk civilian trauma patients sustaining penetrating colon injury, we conditionally recommend that colon repair or R&A be performed rather than routine colostomy. In adult civilian trauma patients sustaining penetrating colon injury who had DCL, we conditionally recommend that routine colostomy not be performed; instead, definitive repair or delayed R&A or anastomosis at initial operation should be performed rather than routine colostomy. LEVEL OF EVIDENCE Systematic review/meta-analysis, Level III Information for Corresponding Author: Daniel C. Cullinane, MD, Marshfield Clinic, 1000 N. Oak Avenue, Marshfield, WI 54449. Phone: 715-389-5219. Fax: 715-389-3336. E-mail:cullinane.daniel@marshfieldclinic.org Conflict of Interest Disclosure: The authors have no conflicts of interest regarding the information presented in this manuscript. Funding: Sources: No external sources of funding were used in the preparation of this manuscript. Presented: This manuscript was not presented at any meeting or conference. © 2018 Lippincott Williams & Wilkins, Inc.

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