Complications of primary repair of colon injury: literature review of 2,964 cases

Objective: To evaluate the safety and efficacy of primary repair of colon injuries. Materials and methods: A literature review was made of 35 publications containing 5,400 colon injuries in retrospective and prospective studies. Results: There were 62 (2.4%) failures in 2,627 primary repairs based on surgeon discretion or absence of risk factors. In prospective series of 337 patients repaired without exclusionary criteria, there were 4 (1.2%) suture line failures (P = not significant). In prospective randomized trials without exclusionary criteria, 127 primary repairs had less morbidity compared with 109 diverted patients (P <0.02). The leak rate after resection and anastomosis (5.5%) is greater than after simple suture of perforation (1.4%; P <0.001). The 66 colon repair leaks were treated by conversion to colostomy or led to fistulae that usually healed spontaneously. A preponderance of failed repairs occurred in the setting of multiple injuries or comorbid conditions. Conclusions: Penetrating and blunt colon injuries in civilian practice are safely managed by primary repair, but colostomy may still be advised in selected cases.