Surgery: Current Research

ISSN - 2161-1076

Role of protective ileostomy in destructive colon injuries in gunshot victims and predictors of post-operative morbidity in a developing nation

2nd International Conference on Surgery and Anesthesia

September 16-18, 2013 Hampton Inn Tropicana, Las Vegas, NV, USA

Tanzeela Gala

Scientific Tracks Abstracts: Surgery Curr Res

Abstract :

Abdominal injury from Gunshot Wounds accounts for up to 90% of the mortality associated with penetrating abdominal injuries. Due to fear of anastomotic leak there still seems to be limited role of diversion. At Aga Khan University Hospital we have progressed from Resection with Hartmann Procedure to Resection and Anastomosis with covering ileostomy in destructive colon injury in gunshot victims. We assessed morbidity with our change of practice and find out factors for post-operative complications. Victims from 2004-2012 were included. Charts were reviewed for demographics and clinical variables. Morbidity and associated risk factors were determined using Mann-Whitney-U-test and chi-square-test where p-value<0.05 was taken as significant. Data was divided into Group-A (Resection with Hartmann) and Group-B (Resection and Anastomosis with ileostomy). Patients in the groups were15 and 27 with median age being 30 and 36 years. Post-operative morbidity was 40% in group A and 26% in group B (p-value 0.48).Median hospital stay has decreased from 15 to 10 days (p-value 0.015). Stoma reversal was done in a median of 9 months to 4 months (p-value 0.010). Post-operative complications included one intra-abdominal abscess, stricture and anastomotic leak in group B, wound dehiscence in 6 patients of each group. On multivariate analysis age > 45 years, transfusion of > 4 packed cells in first 24 hours, post-operative inotropes requirement for > 1 day and pH < 7.35 were associated with post-operative complications. Current study suggests Resection& Anastomosis with ileostomy has acceptable morbidity with early reversal of stoma. This can be safely performed in all patients with destructive colon injuries.

Biography :

Tanzeela Gala - Year III Resident in General Surgery at Aga Khan University Hospital, Karachi, Pakistan; which is equivalent to a level II Trauma Center in USA. She has special interests in Trauma care and Colorectal Surgery and has carried out research in related fields. She also has distinction of being a female surgeon in making which in itself is a major undertaking in our part of the world.