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Improved Outcomes in Colon and Rectal Surgery part 40

Improved Outcomes in Colon and Rectal Surgery part 40. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | improved outcomes in colon and rectal surgery Table 35.1 Flint grades of colonic injury. Grade Mortality3 Complications3 1 2 3 Isolated colon injury minimal contamination no shock minimal delay Through-and-through perforation lacerations moderate contamination Severe tissue loss devascularization heavy contamination 4 20 25 0 20 31 a. n 137. and that was reliable in the acute postinjury setting as opposed to other etiologies for critical illness i.e. sepsis or major operation . Three hundred sixty patients undergoing laparotomy for penetrating trauma were the basis of this study. Each intraabdominal organ was assigned a weight in terms of potential for developing complications and a sub-grading from 1-5 based on severity of the injury. A PATI cutoff of 25 separated a substantial increase in complication rates 17 vs. 50 for stab wounds and 12 vs. 44 for gunshot wounds . Notably this scale provided a basis for the development of the Organ Injury Scale of the American Association for the Surgery of Trauma AAST . In 1987 Dr. Donald Trunkey the president of the AAST at that time appointed the Organ Injury Scaling Committee to derive an injury scaling system that unified several previously proposed scoring systems for the purposes of conducting higher-quality research and to provide a common parlance amongst centers and authors Trunkey DD personal communication . This committee cites the results of 2 prior studies of penetrating colon injuries 47 48 in which scoring systems proved useful to guide management as support for creating this scoring system for all abdominal organs. Their work utilized some of the structure of the PATI proposed by Moore as previously discussed. The AAST Colon Injury Scale is shown in Table 35.2. 49 MANAGEMENT OF PENETRATING COLON INJURY The argument for primary repair The management of penetrating colon injury has undergone significant changes during the past 50 years. Today primary repair is considered the treatment of choice for most colon .