Management of the injured bowel: preserving bowel continuity as a gold standard - Sorbonne Université
Article Dans Une Revue BMC Surgery Année : 2021

Management of the injured bowel: preserving bowel continuity as a gold standard

Résumé

Background: Management of bowel traumatic injuries is a challenge. Although anastomotic or suture leak remains a feared complication, preserving bowel continuity is increasingly the preferred strategy. The aim of this study was to evaluate the outcomes of such a strategy. Methods: All included patients underwent surgery for bowel traumatic injuries at a high volume trauma center between 2007 and 2017. Postoperative course was analyzed for abdominal complications, morbidity and mortality. Results: Among 133 patients, 78% had small bowel injuries and 47% had colon injuries. 87% of small bowel injuries and 81% of colon injuries were treated with primary repair or anastomosis, with no difference in treatment according to injury site (p = 0.381). Mortality was 8%. Severe overall morbidity was 32%, and abdominal complications occurred in 32% of patients. Risk factors for severe overall morbidity were stoma creation (p = 0.036), heavy vascular expansion (p = 0.005) and a long delay before surgery (p = 0.023). Fistula rate was 2.2%; all leaks occurred after repairing small bowel wounds. Conclusion: Primary repair of bowel injuries should be the preferred option in trauma patient, regardless of the site-small bowel or colon-of the injury. Stoma creation is an important factor for postoperative morbidity, which should be weighed against the risk of an intestinal suture or anastomosis.
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Dates et versions

hal-03351652 , version 1 (22-09-2021)

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Camille Tantardini, Gaëlle Godiris-Petit, Séverine Noullet, Mathieu Raux, Fabrice Menegaux, et al.. Management of the injured bowel: preserving bowel continuity as a gold standard. BMC Surgery, 2021, 21 (1), ⟨10.1186/s12893-021-01332-x⟩. ⟨hal-03351652⟩
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