Applicability of an established management algorithm for destructive colon injuries after abbreviated laparotomy

A 17-year experience

John P. Sharpe, Louis J. Magnotti, Jordan A. Weinberg, Charles P. Shahan, Darren R. Cullinan, Katy A. Marino, Timothy Fabian, Martin Croce

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background For more than a decade, operative decisions (resection plus anastomosis vs diversion) for colon injuries, at our institution, have followed a defined management algorithm based on established risk factors (pre- or intraoperative transfusion requirements of more than 6 units packed RBCs and/or presence of significant comorbid diseases). However, this management algorithm was originally developed for patients managed with a single laparotomy. The purpose of this study was to evaluate the applicability of this algorithm to destructive colon injuries after abbreviated laparotomy (AL) and to determine whether additional risk factors should be considered. Study Design Consecutive patients over a 17-year period with colon injuries after AL were identified. Nondestructive injuries were managed with primary repair. Destructive wounds were resected at the initial laparotomy followed by either a staged diversion (SD) or a delayed anastomosis (DA) at the subsequent exploration. Outcomes were evaluated to identify additional risk factors in the setting of AL. Results We identified 149 patients: 33 (22%) patients underwent primary repair at initial exploration, 42 (28%) underwent DA, and 72 (49%) had SD. Two (1%) patients died before re-exploration. Of those undergoing DA, 23 (55%) patients were managed according to the algorithm and 19 (45%) were not. Adherence to the algorithm resulted in lower rates of suture line failure (4% vs 32%, p = 0.03) and colon-related morbidity (22% vs 58%, p = 0.03) for patients undergoing DA. No additional specific risk factors for suture line failure after DA were identified. Conclusions Adherence to an established algorithm, originally defined for destructive colon injuries after single laparotomy, is likewise efficacious for the management of these injuries in the setting of AL.

Original languageEnglish (US)
Pages (from-to)636-641
Number of pages6
JournalJournal of the American College of Surgeons
Volume218
Issue number4
DOIs
StatePublished - Jan 1 2014

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A 17
Laparotomy
Colon
Wounds and Injuries
Sutures
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Applicability of an established management algorithm for destructive colon injuries after abbreviated laparotomy : A 17-year experience. / Sharpe, John P.; Magnotti, Louis J.; Weinberg, Jordan A.; Shahan, Charles P.; Cullinan, Darren R.; Marino, Katy A.; Fabian, Timothy; Croce, Martin.

In: Journal of the American College of Surgeons, Vol. 218, No. 4, 01.01.2014, p. 636-641.

Research output: Contribution to journalArticle

Sharpe, John P. ; Magnotti, Louis J. ; Weinberg, Jordan A. ; Shahan, Charles P. ; Cullinan, Darren R. ; Marino, Katy A. ; Fabian, Timothy ; Croce, Martin. / Applicability of an established management algorithm for destructive colon injuries after abbreviated laparotomy : A 17-year experience. In: Journal of the American College of Surgeons. 2014 ; Vol. 218, No. 4. pp. 636-641.
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abstract = "Background For more than a decade, operative decisions (resection plus anastomosis vs diversion) for colon injuries, at our institution, have followed a defined management algorithm based on established risk factors (pre- or intraoperative transfusion requirements of more than 6 units packed RBCs and/or presence of significant comorbid diseases). However, this management algorithm was originally developed for patients managed with a single laparotomy. The purpose of this study was to evaluate the applicability of this algorithm to destructive colon injuries after abbreviated laparotomy (AL) and to determine whether additional risk factors should be considered. Study Design Consecutive patients over a 17-year period with colon injuries after AL were identified. Nondestructive injuries were managed with primary repair. Destructive wounds were resected at the initial laparotomy followed by either a staged diversion (SD) or a delayed anastomosis (DA) at the subsequent exploration. Outcomes were evaluated to identify additional risk factors in the setting of AL. Results We identified 149 patients: 33 (22{\%}) patients underwent primary repair at initial exploration, 42 (28{\%}) underwent DA, and 72 (49{\%}) had SD. Two (1{\%}) patients died before re-exploration. Of those undergoing DA, 23 (55{\%}) patients were managed according to the algorithm and 19 (45{\%}) were not. Adherence to the algorithm resulted in lower rates of suture line failure (4{\%} vs 32{\%}, p = 0.03) and colon-related morbidity (22{\%} vs 58{\%}, p = 0.03) for patients undergoing DA. No additional specific risk factors for suture line failure after DA were identified. Conclusions Adherence to an established algorithm, originally defined for destructive colon injuries after single laparotomy, is likewise efficacious for the management of these injuries in the setting of AL.",
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T1 - Applicability of an established management algorithm for destructive colon injuries after abbreviated laparotomy

T2 - A 17-year experience

AU - Sharpe, John P.

AU - Magnotti, Louis J.

AU - Weinberg, Jordan A.

AU - Shahan, Charles P.

AU - Cullinan, Darren R.

AU - Marino, Katy A.

AU - Fabian, Timothy

AU - Croce, Martin

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N2 - Background For more than a decade, operative decisions (resection plus anastomosis vs diversion) for colon injuries, at our institution, have followed a defined management algorithm based on established risk factors (pre- or intraoperative transfusion requirements of more than 6 units packed RBCs and/or presence of significant comorbid diseases). However, this management algorithm was originally developed for patients managed with a single laparotomy. The purpose of this study was to evaluate the applicability of this algorithm to destructive colon injuries after abbreviated laparotomy (AL) and to determine whether additional risk factors should be considered. Study Design Consecutive patients over a 17-year period with colon injuries after AL were identified. Nondestructive injuries were managed with primary repair. Destructive wounds were resected at the initial laparotomy followed by either a staged diversion (SD) or a delayed anastomosis (DA) at the subsequent exploration. Outcomes were evaluated to identify additional risk factors in the setting of AL. Results We identified 149 patients: 33 (22%) patients underwent primary repair at initial exploration, 42 (28%) underwent DA, and 72 (49%) had SD. Two (1%) patients died before re-exploration. Of those undergoing DA, 23 (55%) patients were managed according to the algorithm and 19 (45%) were not. Adherence to the algorithm resulted in lower rates of suture line failure (4% vs 32%, p = 0.03) and colon-related morbidity (22% vs 58%, p = 0.03) for patients undergoing DA. No additional specific risk factors for suture line failure after DA were identified. Conclusions Adherence to an established algorithm, originally defined for destructive colon injuries after single laparotomy, is likewise efficacious for the management of these injuries in the setting of AL.

AB - Background For more than a decade, operative decisions (resection plus anastomosis vs diversion) for colon injuries, at our institution, have followed a defined management algorithm based on established risk factors (pre- or intraoperative transfusion requirements of more than 6 units packed RBCs and/or presence of significant comorbid diseases). However, this management algorithm was originally developed for patients managed with a single laparotomy. The purpose of this study was to evaluate the applicability of this algorithm to destructive colon injuries after abbreviated laparotomy (AL) and to determine whether additional risk factors should be considered. Study Design Consecutive patients over a 17-year period with colon injuries after AL were identified. Nondestructive injuries were managed with primary repair. Destructive wounds were resected at the initial laparotomy followed by either a staged diversion (SD) or a delayed anastomosis (DA) at the subsequent exploration. Outcomes were evaluated to identify additional risk factors in the setting of AL. Results We identified 149 patients: 33 (22%) patients underwent primary repair at initial exploration, 42 (28%) underwent DA, and 72 (49%) had SD. Two (1%) patients died before re-exploration. Of those undergoing DA, 23 (55%) patients were managed according to the algorithm and 19 (45%) were not. Adherence to the algorithm resulted in lower rates of suture line failure (4% vs 32%, p = 0.03) and colon-related morbidity (22% vs 58%, p = 0.03) for patients undergoing DA. No additional specific risk factors for suture line failure after DA were identified. Conclusions Adherence to an established algorithm, originally defined for destructive colon injuries after single laparotomy, is likewise efficacious for the management of these injuries in the setting of AL.

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