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

Daniel C. Cullinane, Randeep S. Jawa, John J. Como, Ashlee E. Moore, David S. Morris, Jerry Cheriyan, Oscar D. Guillamondegui, Stephanie R. Goldberg, Laura Petrey, Gregory P. Schaefer, Kosar A. Khwaja, Susan Rowell, Ronald R. Barbosa, Gary A. Bass, George Kasotakis, Bryce R.H. Robinson

    Research output: Contribution to journalReview article

    Abstract

    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 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 damage control laparotomy, 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.

    Original languageEnglish (US)
    Pages (from-to)505-515
    Number of pages11
    JournalJournal of Trauma and Acute Care Surgery
    Volume86
    Issue number3
    DOIs
    StatePublished - Mar 1 2019

    Fingerprint

    Practice Management
    Practice Guidelines
    Meta-Analysis
    Colon
    Colostomy
    Wounds and Injuries
    Laparotomy
    MEDLINE
    Shock
    Prospective Studies
    Hemorrhage
    Mortality

    Keywords

    • Colon injury
    • colon repair
    • colon trauma
    • damage control surgery
    • penetrating abdominal trauma

    ASJC Scopus subject areas

    • Surgery
    • Critical Care and Intensive Care Medicine

    Cite this

    Management of penetrating intraperitoneal colon injuries : A meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma. / Cullinane, Daniel C.; Jawa, Randeep S.; Como, John J.; Moore, Ashlee E.; Morris, David S.; Cheriyan, Jerry; Guillamondegui, Oscar D.; Goldberg, Stephanie R.; Petrey, Laura; Schaefer, Gregory P.; Khwaja, Kosar A.; Rowell, Susan; Barbosa, Ronald R.; Bass, Gary A.; Kasotakis, George; Robinson, Bryce R.H.

    In: Journal of Trauma and Acute Care Surgery, Vol. 86, No. 3, 01.03.2019, p. 505-515.

    Research output: Contribution to journalReview article

    Cullinane, DC, Jawa, RS, Como, JJ, Moore, AE, Morris, DS, Cheriyan, J, Guillamondegui, OD, Goldberg, SR, Petrey, L, Schaefer, GP, Khwaja, KA, Rowell, S, Barbosa, RR, Bass, GA, Kasotakis, G & Robinson, BRH 2019, 'Management of penetrating intraperitoneal colon injuries: A meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma', Journal of Trauma and Acute Care Surgery, vol. 86, no. 3, pp. 505-515. https://doi.org/10.1097/TA.0000000000002146
    Cullinane, Daniel C. ; Jawa, Randeep S. ; Como, John J. ; Moore, Ashlee E. ; Morris, David S. ; Cheriyan, Jerry ; Guillamondegui, Oscar D. ; Goldberg, Stephanie R. ; Petrey, Laura ; Schaefer, Gregory P. ; Khwaja, Kosar A. ; Rowell, Susan ; Barbosa, Ronald R. ; Bass, Gary A. ; Kasotakis, George ; Robinson, Bryce R.H. / Management of penetrating intraperitoneal colon injuries : A meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma. In: Journal of Trauma and Acute Care Surgery. 2019 ; Vol. 86, No. 3. pp. 505-515.
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    abstract = "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 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 damage control laparotomy, 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.",
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    T1 - Management of penetrating intraperitoneal colon injuries

    T2 - A meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma

    AU - Cullinane, Daniel C.

    AU - Jawa, Randeep S.

    AU - Como, John J.

    AU - Moore, Ashlee E.

    AU - Morris, David S.

    AU - Cheriyan, Jerry

    AU - Guillamondegui, Oscar D.

    AU - Goldberg, Stephanie R.

    AU - Petrey, Laura

    AU - Schaefer, Gregory P.

    AU - Khwaja, Kosar A.

    AU - Rowell, Susan

    AU - Barbosa, Ronald R.

    AU - Bass, Gary A.

    AU - Kasotakis, George

    AU - Robinson, Bryce R.H.

    PY - 2019/3/1

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    N2 - 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 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 damage control laparotomy, 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.

    AB - 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 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 damage control laparotomy, 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.

    KW - Colon injury

    KW - colon repair

    KW - colon trauma

    KW - damage control surgery

    KW - penetrating abdominal trauma

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