A Cochrane review [Abstract] 1 included 6 studies with a total of 705 subjects. The primary repair patients were treated with either simple closure of the injury, resection and anastomosis, or intracolonic bypass with anastomosis. The diversion patients were treated with an ileostomy or a diverting colostomy proximal to the injury or by fashioning the injury into a stoma. Mortality was low in both the primary repair (1.94%) and the diverted groups (1.74%) and there was no difference between the groups (The Peto OR 1.22, 95% CI 0.40 to 3.74).
The primary repair group experienced a lower rate of complications (Peto OR 0.54, 95% CI 0.39 to 0.76). The observed difference in the rate of infectious complications did not reach statistical significance (Peto OR 0.44; 95% CI 0.17 to 1.10). There was statistical heterogeneity with these results.
The observed differences in abdominal infections including dehiscence (Peto OR 0.67, 95% CI 0.35 to 1.3), abdominal infections excluding dehiscence (Peto OR 0.69, 95% CI 0.34 to 1.39), wound complications including dehiscence (Peto OR 0.73, 95% CI 0.38 to 1.39), and wound complications excluding dehiscence (Peto OR 0.67, 95% CI 0.32 to 1.39) were not statistically significant. However, statistical significance favoring primary repair over fecal diversion was achieved for all outcomes related to abdominal infections and wound complications when one study was excluded for both clinical and statistical heterogeneity in the sensitivity analysis.
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).
Primary/Secondary Keywords