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Meta-Analysis
. 2002;2003(3):CD002247.
doi: 10.1002/14651858.CD002247.

Primary repair for penetrating colon injuries

R Nelson  1 , M Singer
Affiliations
Meta-Analysis

Primary repair for penetrating colon injuries

R Nelson et al. Cochrane Database Syst Rev. 2002.

Update in

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 the morbidity and mortality of primary repair to fecal diversion in the management of penetrating colon injuries using a meta-analysis of randomized controlled trials.

Search strategy: We searched MEDLINE (1966 to November 2001), the Cochrane Controlled Trials Register, and EMBASE using the terms colon, penetrating, injury, colostomy, prospective, and randomized.

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. Five studies were included.

Data collection and analysis: Reviewers performed data extraction independently. Outcomes evaluated from each trial included mortality, total complications, infectious complications, intra-abdominal infections, wound complications, penetrating abdominal trauma index (PATI), and length of stay. Peto odds ratios for combined effect were calculated with a 95% confidence interval for each outcome. Heterogeneity was assessed for each outcome using a chi-squared test.

Main results: The Penetrating Abdominal Trauma Index (PATI) of included subjects did not significantly differ between studies. Mortality was not significantly different between groups (OR 1.70, 95% CI 0.51,5.66). However, total complications (OR 0.28 95% CI 0.18,0.42), total infectious complications (OR 0.41, 95% CI 0.27, 0.63), abdominal infections including dehiscence (OR 0.59, 95% CI 0.38,0.94), abdominal infections excluding dehiscence (OR 0.52 95% CI 0.31,0.86), wound complications including dehiscence (OR 0.55, 95% CI 0.34,0.89), and wound complications excluding dehiscence (OR 0.43, 95% CI 0.25,0.76) all significantly favored primary repair.

Reviewer's conclusions: Meta-analysis of currently published randomized controlled trials favors primary repair over fecal diversion for penetrating colon injuries.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Primary Repair Mortality versus Fecal Diversion Mortality, Outcome 1 Mortality.
2.1
2.1. Analysis
Comparison 2 Primary Repair Complications versus Fecal Diversion Complications, Outcome 1 Total Complications.
2.2
2.2. Analysis
Comparison 2 Primary Repair Complications versus Fecal Diversion Complications, Outcome 2 Total Infectious Complications.
2.3
2.3. Analysis
Comparison 2 Primary Repair Complications versus Fecal Diversion Complications, Outcome 3 Abdominal Infections Including Dehiscence.
2.4
2.4. Analysis
Comparison 2 Primary Repair Complications versus Fecal Diversion Complications, Outcome 4 Abdominal Infections Excluding Dehiscence.
2.5
2.5. Analysis
Comparison 2 Primary Repair Complications versus Fecal Diversion Complications, Outcome 5 Wound Complications Including Dehiscence.
2.6
2.6. Analysis
Comparison 2 Primary Repair Complications versus Fecal Diversion Complications, Outcome 6 Wound Complications Excluding Dehiscence.
3.1
3.1. Analysis
Comparison 3 Primary Repair PATI versus Fecal Diversion PATI, Outcome 1 PATI.
4.1
4.1. Analysis
Comparison 4 Sensitivity Analyses, Outcome 1 Abdominal Infections Including Dehiscence.
4.2
4.2. Analysis
Comparison 4 Sensitivity Analyses, Outcome 2 Abdominal Infections Excluding Dehiscence.
4.3
4.3. Analysis
Comparison 4 Sensitivity Analyses, Outcome 3 Wound Complications Including Dehiscence.
4.4
4.4. Analysis
Comparison 4 Sensitivity Analyses, Outcome 4 Wound Complications Excluding Dehiscence.
See this image and copyright information in PMC

References

References to studies included in this review

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