Eficacia del cierre primario versus la colostomía en pacientes con trauma penetrante de colon: revisión sistemática

Abstract

Background: Penetrating colon trauma is a highly complex injury, mainly associated with motor vehicle accidents, occupational accidents, and assaults with sharp or firearms. In Ecuador, it represents the tenth leading cause of death, accounting for 2.53% of all deaths. Traditionally, surgical management was performed using colostomy; currently, primary closure is the preferred technique. Objective: To analyze the efficacy of primary closure compared with colostomy in patients with penetrating colon trauma through a systematic review of clinical trials that evaluate postoperative complications, length of hospital stay, recovery time, morbidity, and mortality. Methodology: The review was conducted following the PRISMA 2020 guidelines. The databases used included PubMed, ScienceDirect, SciELO, and the Cochrane Library, with searches updated through 2024. To assess the risk of bias in randomized clinical trials, the “Risk of Bias 2 (RoB2)” tool from the “Cochrane Collaboration” was applied. Results: A total of 19 studies were included, all of which were clinical trials. The studies were observational and analytical in nature. Medical intervention should be individualized according to the patient’s hemodynamic status and the severity of the injuries. Conclusions: Primary closure is considered the first therapeutic option for treating penetrating colon trauma; however, its application may be limited in cases where injuries involve more than 50% of the intestinal circumference or in the presence of postoperative complications require a second intervention. Regarding the length of hospital stay, it ranges from 5 to 6 days for primary closure, whereas for colostomy it is approximately 10 days. Keywords: primary closure, colostomy, penetrating colon trauma