BACKGROUND: Although colon
wounds are commonly treated in the setting of damage control laparotomy (DCL), a paucity of data exist to guide management. The purpose of this study was to evaluate our experience with the management of
colonic wounds in the context of DCL, using
colonic wound outcomes after routine, single laparotomy (SL) as a benchmark. METHODS: Consecutive patients during a 7-year period with full-thickness or devitalizing colon
injury were identified. Early deaths (<48 hour) were excluded. Colon-related complications (
abscess, suture or staple
leak, and stomal
ischemia) were compared between those managed in the setting of DCL versus those managed by SL, both overall and as stratified by procedure (primary repair, resection and
anastomosis, and resection and
colostomy). RESULTS: One hundred fifty-seven patients met study criteria: 101 had undergone SL and 56 had undergone DCL. Comparison of DCL patients with SL patients was notable for a significant difference in colon-related complications (30% vs. 12%, p < 0.005) and suture/staple
leak in particular (12% vs. 3%, p < 0.05). Stratification by procedure revealed a significant difference in colon-related complications among those that underwent resection and
anastomosis (DCL: 39% vs. SL: 18%, p < 0.05), whereas no differences were observed in those who underwent primary repair or resection and
colostomy. CONCLUSIONS: Management of
colonic wounds in the setting of DCL is associated with a relatively high incidence of complications. The excessive incidence of
leak overall and
morbidity particular to resection and
anastomosis, however, give us pause. Although
stoma construction is not without its own complications in the setting of DCL, it may be the safer alternative.
