Canadian attitudes toward use of primary repair in management of colon trauma

Abstract

The majority of recent American articles on management of colon trauma promote liberal use of primary repair. The extent to which Canadian surgeons have embraced such recommendations is unknown. To determine the current attitude of Canadian surgeons toward the use of primary repair, we surveyed the members of The Canadian Association of General Surgeons regarding their management of three fictitious cases of penetrating and blunt colon trauma. Three hundred seventeen members of the Canadian Association of General Surgeons responded. Ninety-two percent managed a fictitious case of early, uncontaminated stab wounds by primary repair. Delay in treatment or fecal contamination was associated with a significantly reduced number of respondents choosing primary repair (P < 0.001). Surgeons were less likely to choose primary repair for management of a case of blunt colon injury (35 percent; P <0.001), and only 25 percent considered primary repair an option for a case of low velocity bullet wounds; 2 percent chose it for high velocity bullet wounds. Overall, the most common response to colon trauma scenarios was colostomy. However, 96 percent of respondents selected primary repair as the treatment of choice for at least one clinical situation depicted in the questionnaire. The likelihood of choosing primary repair was independent of surgeons' experiences or the level of the surgeons' trauma center. Although there are still settings in which many Canadian surgeons consider colostomy the appropriate treatment for colon injuries, primary repair has definitely established a foothold in all levels of Canadian general surgery practice.