Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent?
| Autor: | Gonzalo Aristizábal, Michael W. Parra, Luis Eduardo Toro, Yaset Caicedo, Federico Coccolini, Mario Alain Herrera, Alberto García, Adolfo González-Hadad, Alexander Salcedo, Laureano Quintero, Maria Josefa Franco, Fernando Rodríguez-Holguín, José Julián Serna, Luis Fernando Pino, Mónica Guzmán-Rodríguez, Ricardo Ferrada, Edison Angamarca, Carlos A. Ordoñez, Fabian Hernández, Natalia Padilla, Rao R. Ivatury |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
Damage control Deferred Anastomosis Fistula medicine.medical_treatment Wounds Penetrating Anastomotic Leak Anastomosis Primaria Review Ostomía Lesiones penetrantes de intestino delgado y colon Anastomosis Diferida Surgical anastomosis Injury Severity Score Laparotomy Intestine Small Hollow viscus Cirugía de Control de Daños Anastomosis Surgical Enterostomy General Medicine Damage control surgery Female Adult medicine.medical_specialty Consensus Penetrating Combined Small and Large Bowel Injuries Ostomy Definitive Laparotomy Hemorrhage Colombia Anastomosis Articulo De Revisión Young Adult Medical Illustration Primary Anastomosis medicine Humans Intestine Large Retrospective Studies business.industry medicine.disease Surgery Damage Control Surgery Surgical Anastomosis Laparotomía Definitiva Wounds Gunshot business Penetrating trauma |
| Zdroj: | Colombia Médica, Volume: 52, Issue: 2, Article number: e4114425, Published: 27 APR 2021 Colombia Médica : CM |
| Popis: | Hollow viscus injuries represent a significant portion of overall lesions sustained during penetrating trauma. Currently, isolated small or large bowel injuries are commonly managed via primary anastomosis in patients undergoing definitive laparotomy or deferred anastomosis in patients requiring damage control surgery. The traditional surgical dogma of ostomy has proven to be unnecessary and, in many instances, actually increases morbidity. The aim of this article is to delineate the experience obtained in the management of combined hollow viscus injuries of patients suffering from penetrating trauma. We sought out to determine if primary and/or deferred bowel injury repair via anastomosis is the preferred surgical course in patients suffering from combined small and large bowel penetrating injuries. Our experience shows that more than 90% of all combined penetrating bowel injuries can be managed via primary or deferred anastomosis, even in the most severe cases requiring the application of damage control principles. Applying this strategy, the overall need for an ostomy (primary or deferred) could be reduced to less than 10%. Resumen El trauma de las vísceras huecas representa una gran proporción de las lesiones asociadas al trauma penetrante. Actualmente, las lesiones aisladas de intestino delgado o colon se manejan a través de anastomosis primaria en pacientes sometidos a laparotomía definitiva o anastomosis diferida en pacientes que requieran cirugía de control de daños. El dogma quirúrgico tradicional de la ostomía se ha probado que es innecesario y en muchos casos puede aumentar la morbilidad. El objetivo de este artículo es describir la experiencia obtenida en el manejo de lesiones combinadas de vísceras huecas de pacientes con trauma penetrante. Se determinó que el manejo primario o diferido del intestino a través de anastomosis es el abordaje quirúrgico preferido en pacientes que presentan lesiones penetrantes combinadas de intestino delgado y colon. Se ha reportado que el 90% de lesiones combinadas penetrantes intestinales pueden ser manejadas a través de anastomosis primaria o diferida incluso en los casos más severos requieren la aplicación de los principios de control de daños. Aplicando esta estrategia, la tasa general para ostomía (primaria o diferida) puede ser reducida a menos del 10%. |
| Databáze: | OpenAIRE |
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