Risk Factors and Outcomes of Anastomotic Failure in Combat-Related Penetrating Abdominal Trauma: A Study from Sana'a, Yemen

doi:10.21203/rs.3.rs-4926664/v1

Download PDF

Research Article

Risk Factors and Outcomes of Anastomotic Failure in Combat-Related Penetrating Abdominal Trauma: A Study from Sana'a, Yemen

https://doi.org/10.21203/rs.3.rs-4926664/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Purpose: Anastomotic failure is a severe complication following intestinal resection for combat-related penetrating abdominal trauma, leading to significant morbidity and mortality. This study evaluates the incidence, risk factors, and impact of anastomotic failure in military trauma patients in Sana'a City, Yemen.

Patients and methods: A prospective observational study was conducted at 48 Model Hospital from 2020 to 2023, involving 61 male combat trauma patients who underwent exploratory laparotomy. Data on demographics, injury characteristics, surgical details, and outcomes were collected and analyzed. Logistic regression was used to identify significant risk factors for anastomotic failure.

Results: The overall anastomotic failure rate was 9.8% (6 out of 61 patients). Significant risk factors included preoperative blood transfusion (OR 0.180, 95% CI: 0.019-1.758, p=0.140), stomach injury (OR 0.102, 95% CI: 0.006-1.858, p=0.123), and large bowel injury, though with wide confidence intervals indicating variability. Patients with anastomotic failure had higher rates of septicemia (45% vs. 10%, p=0.03) and longer hospital stays (21.4 ± 6.2 days vs. 13.1 ± 4.1 days, p<0.01).

Conclusion: Identifying key risk factors for anastomotic failure in military trauma patients underscores the need for proactive strategies to minimize this complication and improve patient outcomes. Enhanced preoperative assessment, meticulous surgical technique, and vigilant postoperative monitoring are crucial for reducing the incidence of anastomotic failure in this high-risk population.

Gastrointestinal Surgery

Anastomotic failure

penetrating trauma

abdominal trauma

intestinal resection

exploratory laparotomy

surgical complications

risk factors

Abdominal trauma is a common and potentially life-threatening injury pattern in military conflicts, accounting for a substantial proportion of combat-related injuries.¹ Managing these complex injuries poses significant challenges due to the often-devastating nature of penetrating wounds, the frequent presence of multiple associated injuries, and resource constraints in austere military environments.^2,3 One critical aspect of managing abdominal injuries is the performance of intestinal anastomoses, required to restore gastrointestinal continuity after resection of the damaged bowel.

Anastomotic failure is a serious complication that can occur after intestinal anastomosis, leading to substantial morbidity, mortality, and increased healthcare resource utilization.⁴ This complication is particularly concerning in military trauma populations, where patients may be hemodynamically unstable, have multiple concurrent injuries, and require rapid surgical intervention.⁵ Despite advances in surgical techniques and perioperative care, anastomotic failure remains a challenging problem in managing combat-related abdominal trauma.⁶

Reported rates of anastomotic failure in military trauma populations vary widely, ranging from 4–24% across different studies.^7,8 This variation is likely due to differences in injury patterns, surgical techniques, and postoperative management across various combat environments and patient cohorts. Factors such as the need for emergency surgery, the presence of multiple intra-abdominal injuries, and patient hemodynamic instability contribute to the increased risk of anastomotic failure in military trauma.^9,10 Comparing these rates to civilian trauma, where blunt injuries are more prevalent, provides essential insights into the unique challenges of military settings.

Given the significant morbidity and potential mortality associated with anastomotic failure, understanding its incidence, risk factors, and impact is critical. This knowledge can inform strategies to mitigate risks, optimize surgical decision-making, and improve outcomes for these critically injured patients. However, there is a relative paucity of research specifically examining anastomotic outcomes in contemporary military abdominal trauma, particularly in resource-limited settings.

This study aimed to evaluate anastomotic outcomes in exploratory laparotomies for patients with conflict-related penetrating abdominal trauma in Sana'a City, Yemen. By focusing on this specific context, we sought to determine the incidence of anastomotic failure, identify associated risk factors, and examine its impact on patient morbidity and mortality. Our findings contribute valuable information on managing intestinal injuries in combat trauma and underscore the need for ongoing research to improve outcomes in these complex and high-risk patients. These insights may also inform clinical practice and policy development, enhancing trauma care in similar environments.

Study Design and Setting

This prospective observational study was conducted at 48 Model Hospital in Sana'a City, Yemen, from 2020 to 2023. As a referral center for trauma cases, the hospital provides comprehensive care for patients with combat-related injuries, making it an ideal setting for this study.

Patient Selection

The study included all consecutive patients who underwent bowel resection and anastomosis during exploratory laparotomy for conflict-related penetrating abdominal trauma. Exclusion criteria were patients who died within 24 hours post-surgery or those undergoing laparotomy for non-trauma indications. This selection ensured a focused cohort of patients relevant to the study objectives.

Data Collection

Data were collected prospectively using a standardized form to capture demographic information, trauma details, surgical procedures, and outcomes. Key variables included age, mechanism of injury, type of surgery, location of bowel injury, presence of stomach injury, and preoperative blood transfusion. Additional data on intraoperative findings and postoperative complications, such as wound infections and reoperation rates, were also recorded. Data collection was performed by trained research staff to ensure accuracy and consistency.

Surgical Technique

Exploratory laparotomies were performed using a midline incision that spanned from the xiphoid to the pubis. The abdominal cavity was explored systematically to identify all injuries. Contamination was minimized by isolating the injury site from the rest of the abdomen with packs.

Anastomoses were performed using standard techniques based on the location and nature of the injury. For small bowel injuries, primary repair or resection with anastomosis was employed. For colon injuries, the approach depended on the extent of the injury and the patient's stability, ranging from primary repair and resection with anastomosis to colostomy diversion. Hand-sewn anastomoses were performed in two layers using absorbable sutures; the first layer was sutured continuously, while the second layer was sutured interruptedly.

Damage control surgery was employed for patients in severe shock (SBP < 60 mmHg). This approach involved rapid control of hemorrhage and contamination, temporary abdominal closure, and planned re-laparotomy once the patient had stabilized. Definitive anastomoses were performed during the re-laparotomy..

Outcome Measures

The primary outcome measure was the incidence of anastomotic failure, defined as clinical evidence of a leak requiring intervention. Secondary outcomes included factors associated with anastomotic failure and its impact on complications, such as septicemia, and length of hospital stay.

Statistical Analysis

Descriptive statistics were used to summarize patient demographics and clinical characteristics. Logistic regression analysis was performed to identify significant risk factors for anastomotic failure, with odds ratios (OR) and 95% confidence intervals (CI) reported. Multicollinearity was assessed using variance inflation factors (VIF), and significance was set at p < 0.05.

A total of 61 patients, all male, were included in this study, representing 100% of the study population. The median age of participants was 24 years (range 15–45). All patients presented with penetrating abdominal injuries; no blunt injuries were recorded. The mean time from injury to presentation was 14.5 ± 5.59 hours. The most common injury mechanism was gunshot wounds (69%), followed by blast injuries (31%). Of the 61 patients, 25 (41%) were hemodynamically unstable (SBP < 90 mmHg) upon arrival at the emergency department, with 12 (48%) of these unstable patients requiring preoperative blood transfusions. Injury Severity Scores (ISS) indicated that 51% of patients had severe injuries (ISS 16–24), 29% had critical injuries (ISS ≥ 25), and 20% had moderate injuries (ISS 9–15). Additionally, 67.2% of patients had extra-abdominal injuries, including chest (25%), pelvis (15%), soft tissue (15%), extremities (10%), spine (8%), head and neck (1.6%), and penile shaft (1.6%) injuries (Table 1).

Table 1

Demographic characteristics of the study population
Demographic Characteristic	Frequency	Percentage
Age (Median, IQR)	24 (15–45) years	-
Gender
Male	61	100%
Mechanism of Injury
Penetrating abdominal injury	61	100%
GSW injury	42	69%
Blast injury	19	31%
Hemodynamic Status
Stable	36	59%
Unstable (SBP < 90 mmHg)	25	41%
Injury Severity Score (ISS)
Severe (16–24)	31	51%
Critical (≥ 25)	18	29%
Moderate (9–15)	12	20%
Extra-Abdominal Injury	41	67.2%
Chest injury	15	25%
Pelvis fracture	9	15%
Soft tissue injury	9	15%
Extremity injury	6	10%
Spine injury	5	8%
Head and neck injury	1	1.6%
Penile shaft injury	1	1.6%
Preoperative Blood Transfusion	13	21.3%
Amount of Blood Transfused (Median, IQR)	2 (1–3) units	-
Time from Injury to Presentation (Mean ± SD)	14.5 ± 5.59 hrs	-

The median time from presentation to operation was 12 hours (IQR: 1–38 hours). Emergency laparotomy was performed in 98.4% of cases, with a median operative time of 140 minutes (IQR: 50–250 minutes). Almost all patients (98.4%) required intraoperative blood transfusions, with a median amount of 2 units (IQR: 1–8 units). Bowel injuries primarily involved the small intestine (87%) compared to the large intestine (54%). Associated intra-abdominal injuries included bladder (10%), liver (8%), and ureteric (5%) injuries. Intraoperative complications occurred in 13% of cases, and surgeries were performed by surgeons with varying levels of experience (Table 2).

Table 2

**Intraoperative characteristics and findings among the study population**
Intraoperative Data	Frequency	Percentage
Time from Presentation to Operation (Median, IQR)	12 (1–38) hours	-
Type of Laparotomy
Emergency laparotomy	60	98.4%
Damage control laparotomy	1	1.6%
Intraoperative Blood Transfusion	60	98.4%
Intraoperative Blood Transfusion (Median, IQR)	2 (1–8) units	-
Location of Bowel Injury
Small bowel injury	53	87%
Large bowel injury	33	54%
Stomach injury	4	7%
Rectum injury	3	5%
Associated Intra-Abdominal Injuries
Bladder injury	6	10%
Liver injury	5	8%
Ureteric injury	3	5%
Vascular injury	3	5%
Diaphragmatic injury	2	3.3%
Retroperitoneal hematoma	2	3.3%
Mesenteric injury	2	3.3%
Mesocolon injury	2	3.3%
Splenic injury	1	1.6%
Kidney injury	1	1.6%
Pancreatic injury	1	1.6%
Gallbladder injury	1	1.6%
Anastomotic Connection
Small bowel to small bowel	44	72%
Small bowel to large bowel	11	18%
Large bowel to large bowel	7	11.5%
Gastric to small bowel	2	3.3%
Total Anastomoses (Median, IQR)	1 (1–2)	-
Operative Time (Median, IQR)	140 (50–250) min	-
Surgeon Experience
< 5 years	17	27.9%
5–10 years	27	44.3%
More than 10 years	17	27.9%
Intraoperative Complications	8	13%

In the study population, the most common type of anastomosis was small intestine to small intestine (72%). Anastomotic failure occurred in 6 cases, with an incidence rate of 9.8%. The mean time to anastomotic failure postoperatively was 8.5 ± 151 days. Types of anastomotic failure included leaks (8%), intra-abdominal abscesses (7%), and enterocutaneous fistulas (3.3%). Management strategies for anastomotic failure varied, including end ileostomy (50%), reanastomosis with gastrojejunostomy (17%), Hartman colostomy (17%), and conservative management (17%) (Table 3).

Table 3

**Anastomotic characteristics and outcomes**
Anastomotic Characteristics	Frequency	Percentage
Anastomotic Connection
Small bowel to small bowel	44	72%
Small bowel to large bowel	11	18%
Large bowel to large bowel	7	11.5%
Gastric to small bowel	2	3.3%
Total Anastomoses (Median, IQR)	1 (1–2)	-
Anastomotic Failure
Yes	6	9.8%
No	55	90.2%
Time to Anastomotic Failure (Mean ± SD)	8.5 ± 151 days	-
Type of Anastomotic Failure
Leak	5	8%
Intra-abdominal Abscess	4	7%
Enterocutaneous Fistula	2	3.3%
Management of Anastomotic Failure
End ileostomy	3	50%
Re-anastomosis with Gastrojejunostomy	1	17%
Hartman colostomy	1	17%
Conservative management	1	17%

Patients with anastomotic failure (n = 6) experienced a higher rate of postoperative complications (100%) compared to those without failure (62%), though this difference was not statistically significant (p = 0.085). Superficial surgical site infections were more common in patients with failure (100% vs. 68%), but the difference was not significant (p = 0.162). Other complications, including deep space infections, wound dehiscence, and chest infections, showed no significant differences between the groups.

Septicemia was significantly more prevalent in patients with anastomotic failure (100% vs. 56%, p = 0.040). Additionally, patients with failure had longer hospital stays (38 days vs. 12 days, p < 0.001), prolonged postoperative pain (15 days vs. 4 days, p < 0.001), and extended NPO duration (8 days vs. 5 days, p < 0.001). There was one mortality in the failure group compared to four in the non-failure group, but the difference was not significant (p = 0.415) (Table 4).

Table 4

Postoperative outcomes stratified by the occurrence of anastomotic failure
Postoperative Data	Anastomotic Failure		Total (N = 61)	P-value
Postoperative Data	Patients with (N = 6)	Patients without (N = 55)	Total (N = 61)	P-value
Postoperative Complications	6 (100%)	34 (62%)	40 (66%)	0.085
Superficial SSI	6 (100%)	23 (68%)	29 (72.5%)	0.162
Deep Space SSI	1 (17%)	4 (12.5%)	5 (13%)	1.000
Wound Dehiscence	2 (33%)	12 (35%)	14 (35%)	1.000
Chest Infection	2 (33%)	14 (41%)	16 (40%)	1.000
ARDS	0	2 (6%)	2 (5%)	1.000
Paralytic Ileus	3 (50%)	13 (40.6%)	16 (42%)	0.682
DIC	0	6 (19%)	6 (16%)	0.248
Reoperation	0	3 (10%)	3 (8%)	1.000
Early Intestinal Obstruction	0	1 (3%)	1 (2.6%)	1.000
Bleeding	1 (17%)	1 (3%)	2 (5%)	0.286
Bile Leak	1 (17%)	1 (3%)	2 (5%)	0.286
Sepsis	6 (100%)	19 (56%)	25(62.5%)	0.040*
DVT	0	1 (3%)	1 (2.5%)	1.000
Mortality	1	4	5	0.415
LOS (Median, IQR)	38 (21–78)	12 (5–36)	13 (5–78)	< 0.001^µ
Duration of Postoperative Pain (Median, IQR)	15 (12–21)	4 (0–23)	5 (0–23)	< 0.001^µ
Postoperative NPO Duration (Median, IQR)	8 (5–14)	5 (3–16)	5 (3–16)	< 0.001^µ
Note: Significant p-value < 0.05; µ Mann-Whitney U Test. Abbreviations:* ARDS: Acute Respiratory Distress Syndrome; SSI: Surgical Site Infection; LOS: Length of Hospital Stay; IQR: interquartile range; NPO: Nil Per Mouth; DIC: Disseminated Intravascular Coagulation; DVT: Deep Vein Thrombosis

Regarding risk factors for anastomotic failure, a higher proportion of patients who experienced anastomotic failure had received preoperative blood transfusions (67% vs. 16%, p = 0.016), with an odds ratio (OR) of 10.222 (95% CI, 1.621–64.467), indicating a markedly increased risk. Emergency laparotomy was performed in 83% of patients with anastomotic failure compared to 100% in those without failure, with a significant association (p = 0.002) and an OR of 0.083 (95% CI, 0.036–0.193). Although nearly all patients underwent emergency procedures, the slightly lower percentage in the failure group highlights the impact of additional factors. Large bowel injury was present in all patients with anastomotic failure (100% vs. 49%, p = 0.027), with an OR of 1.222 (95% CI, 1.041–1.435), suggesting a substantial association with failure. Stomach injuries were also significantly associated with anastomotic failure (33% vs. 4%, p = 0.045), with an OR of 13.250 (95% CI, 1.457-120.516), highlighting the increased risk in these patients. (Table 5).

Table 5

Bivariate analysis of factors associated with anastomotic failure
Risk Factors	Anastomotic Failure		P-value	Odds Ratio	95% CI
Risk Factors	Patients with (N = 6)	Patients without (N = 55)	P-value	Odds Ratio	95% CI
Preoperative Blood Transfusion	4 (67%)	9 (16%)	0.016^f	10.222	1.621–64.467
Emergency Laparotomy	5 (83%)	55 (100%)	0.002^*	0.083	0.036–0.193
Large Bowel Injury Location	6 (100%)	27 (49%)	0.027^f	1.222	1.041–1.435
Stomach Injury Location	2 (33%)	2 (4%)	0.045^f	13.250	1.457-120.516

Note: *Significant p-value < 0.05; µ Mann-Whitney U Test.

This study evaluated anastomotic outcomes in exploratory laparotomies for patients with conflict-related abdominal trauma in Sana'a City, Yemen, focusing on incidence rates, associated risk factors, and the impact on morbidity and mortality.

The cohort consisted entirely of young males, with a median age of 24 years, typical for military trauma patients. The exclusive presence of penetrating injuries, predominantly gunshot wounds, reflects the combat setting, contrasting with civilian trauma where blunt injuries are more common.¹¹ The high Injury Severity Scores (ISS) and frequent extra-abdominal injuries underscore the polytrauma nature of these cases, complicating management and influencing outcomes. These findings align with previous studies on modern combat trauma.¹²

Nearly half of the patients were hemodynamically unstable at presentation, highlighting the severity of these injuries. Despite this, the relatively modest transfusion requirements suggest that damage control resuscitation may mitigate the need for extensive preoperative transfusions. This approach, emphasizing early surgical control of bleeding and judicious use of blood products, aligns with current military trauma guidelines.¹¹

Intraoperative care reflected the urgent and complex nature of combat injuries. The prolonged median time from presentation to operation underscores the logistical challenges in resource-constrained environments. The near-universal use of emergency laparotomy and high rates of intraoperative transfusion underscore the critical condition of these patients, necessitating immediate intervention and aggressive resuscitation. These practices are consistent with damage control surgery principles, prioritizing rapid control of bleeding and contamination.⁸

The predominance of small bowel injuries reflects their vulnerability to penetrating trauma. Associated intraabdominal injuries, such as bladder and liver damage, highlight the complexity of these cases and the need for thorough abdominal exploration. Intraoperative complications occurred in 13% of cases, emphasizing the challenges of performing complex surgeries in unstable patients.¹³ Variation in surgeon experience underscores the importance of ongoing training and mentorship in military trauma care.

The anastomotic failure rate of 9.8% falls within reported ranges in the literature, highlighting the variability in outcomes based on injury type, surgical technique, and postoperative care. This rate aligns with previous studies, ^8,14,15 such as Walker et al. (2022), which reported a 15% failure rate in similar populations.⁵

Patients with anastomotic failure experienced significantly higher rates of septicemia and prolonged hospital stays, reflecting the severe morbidity associated with this complication.¹⁶ These findings underscore the need for vigilant monitoring and aggressive management. The significantly higher incidence of septicemia emphasizes the critical need for timely intervention.¹⁷ Prolonged hospitalization and increased resource utilization in these patients reflect the substantial burden of anastomotic failure on both patients and the healthcare system.¹⁸

Management of anastomotic failure varied widely, including the use of stomas and conservative management in select cases. The frequent use of diversion procedures underscores the need for definitive management in unstable patients, while successful conservative management in some cases highlights the potential for nonoperative strategies.^13,19

Significant risk factors for anastomotic failure included preoperative blood transfusion, emergency laparotomy, and specific injury locations such as the large bowel and stomach. These findings suggest that transfusion requirements may indicate overall instability and increased complication risk.^5,15 The association between emergency laparotomy and anastomotic failure reflects the urgent nature of military trauma, consistent with findings from other studies on combat casualty care.^20,21

This study has several important implications for clinical practice, training, and policy development in the management of military trauma patients. It highlights the need for enhanced preoperative assessment and careful surgical planning to reduce anastomotic failure rates. By identifying key risk factors, the findings can guide surgical decision-making and improve patient outcomes. Additionally, the emphasis on mentorship and continuous training for military surgeons underscores the importance of maintaining proficiency in managing complex abdominal trauma cases. The results may also inform protocols for damage control surgery and resuscitation in combat settings, emphasizing rapid intervention and resource management.

However, the study has limitations, including its single-center design, which may limit the generalizability of the findings to other settings or populations. The relatively small sample size, particularly of cases with anastomotic failure, may reduce the statistical power to detect significant differences. While the prospective nature of the study enhances data accuracy, the lack of long-term follow-up prevents assessment of the lasting impact of anastomotic failure on recovery and quality of life. Future research should address these limitations by including larger, multicenter cohorts and incorporating long-term follow-up to validate findings and enhance understanding of anastomotic failure in military trauma contexts.

This study identifies key risk factors for anastomotic failure in penetrating abdominal trauma and emphasizes the importance of preoperative optimization, careful surgical technique, and vigilant postoperative care. Addressing these factors may reduce the incidence of anastomotic failure and improve outcomes in this high-risk population. Limitations of the study, including its small sample size and focus on a single center, may affect generalizability. Future research should include larger, multicenter studies to validate these findings and explore additional strategies for reducing morbidity and mortality associated with anastomotic failure in military trauma.

Ethical Considerations

Ethical approval was obtained from the Ethics Committee of 48 Model Hospital. Informed consent was obtained from all participants or their legal guardians, ensuring confidentiality and voluntary participation in the study. The study was carried out according to the Declaration of Helsinki.

Informed Consent

Informed consent was obtained from all individual participants included in the study or their legal guardians.

Conflict of Interest:

The authors declare that they have no conflict of interest.

Funding

No external funding was received for this study.

Acknowledgments

Not applicable .

Authors’ Contributions

M.A.I. conceptualized the study, collected the data, and wrote the original draft. I.M.S. contributed to the methodology, performed data analysis, and was involved in writing and reviewing the manuscript. Y.A.O. supervised the study and managed the project administration. H.M.J. was responsible for investigation and data curation.

Rignault DP (1992) Abdominal trauma in war. World J Surg 16(5):940–946. 10.1007/BF02066996
Morrison JJ, Clasper JC, Gibb I, Midwinter M (2011) Management of Penetrating Abdominal Trauma in the Conflict Environment: The Role of Computed Tomography Scanning. World J Surg 35(1):27–33. 10.1007/s00268-010-0782-z
Leong M, Edgar I, Terry M (2016) Penetrating abdominal injury: UK military experience from the Afghanistan conflict. J R Nav Med Serv 102(2):90–94. 10.1136/jrnms-102-90
Le KDR, Martin K, Read D (2024) The impact of stapled compared to handsewn repair on anastomotic outcomes in trauma patients: a systematic review and meta-analysis. ANZ J Surg 94(4):604–613. 10.1111/ans.18925
Walker PF, Bozzay JD, Schechtman DW et al (2022) Anastomotic Outcomes in Military Exploratory Laparotomies in the Modern Combat Era. Am Surg 88(4):710–715. 10.1177/00031348211050281
Vertrees A, Wakefield M, Pickett C et al (2009) Outcomes of Primary Repair and Primary Anastomosis in War-Related Colon Injuries. J Trauma: Injury Infect Crit Care 66(5):1286–1293. 10.1097/TA.0b013e31819ea3fc
Ahern DP, Kelly ME, Courtney D, Rausa E, Winter DC (2017) The management of penetrating rectal and anal trauma: A systematic review. Injury 48(6):1133–1138. 10.1016/j.injury.2017.03.002
Smith IM, Beech ZKM, Lundy JB, Bowley DM (2015) A prospective observational study of abdominal injury management in contemporary military operations: Damage control laparotomy is associated with high survivability and low rates of fecal diversion. Ann Surg 261(4):765–773. 10.1097/SLA.0000000000000657
Murray JA, Demetriades D, Colson M et al (1999) Colonic Resection in Trauma: Colostomy Versus Anastomosis. J Trauma Acute Care Surg. ;46(2). https://journals.lww.com/jtrauma/fulltext/1999/02000/colonic_resection_in_trauma__colostomy_versus.9.aspx
Telem DA (2010) Risk Factors for Anastomotic Leak Following Colorectal Surgery. Arch Surg 145(4):371. 10.1001/archsurg.2010.40
Sambasivan CN, Underwood SJ, Cho SD et al (2010) Comparison of Abdominal Damage Control Surgery in Combat Versus Civilian Trauma. J Trauma: Injury Infect Crit Care 69(1):S168–S174. 10.1097/TA.0b013e3181e45cef
Popivanov G, Mutafchiyski VM, Belokonski EI, Parashkevov AB, Koutin GL (2014) A modern combat trauma. J R Army Med Corps 160(1):52–55. 10.1136/jramc-2013-000132
Watson JDB, Aden JK, Engel JE, Rasmussen TE, Glasgow SC (2014) Risk factors for colostomy in military colorectal trauma: A review of 867 patients. Surgery 155(6):1052–1061. 10.1016/j.surg.2014.01.010
Saleh A, Eissa M, Obadiel Y, Alsanabani A (2023) Early Postoperative Complications after Exploratory Laparotomy for Abdominal Trauma. Ain Shams J Surg 16(4). 10.21608/asjs.2023.325733
Mauser M, Bartsokas C, Brand M, Plani F (2019) Postoperative CD4 counts predict anastomotic leaks in patients with penetrating abdominal trauma. Injury 50(1):167–172. 10.1016/j.injury.2018.11.028
Bozzay JD, Walker PF, Schechtman DW et al (2021) Outcomes of Exploratory Laparotomy and Abdominal Infections Among Combat Casualties. J Surg Res 257:285–293. 10.1016/J.JSS.2020.07.075
Midura EF, Hanseman D, Davis BR et al (2015) Risk Factors and Consequences of Anastomotic Leak After Colectomy. Dis Colon Rectum 58(3):333–338. 10.1097/DCR.0000000000000249
Eberhardt JM, Kiran RP, Lavery IC (2009) The Impact of Anastomotic Leak and Intra-Abdominal Abscess on Cancer-Related Outcomes After Resection for Colorectal Cancer. Dis Colon Rectum 52(3):380–386. 10.1007/DCR.0b013e31819ad488
Sambasivan CN, Underwood SJ, Kuehn RB et al (2011) Management and Outcomes of Traumatic Colon Injury in Civilian and Military Patients. Am Surg 77(12):1685–1691. 10.1177/000313481107701244
Pengelly S, Berry JEA, Herrick SE, Bowley DM, Carlson GL (2018) Outcome of open abdominal management following military trauma. Br J Surg 105(8):980–986. 10.1002/bjs.10813
Hanna K, Asmar S, Ditillo M et al (2021) Readmission With Major Abdominal Complications After Penetrating Abdominal Trauma. J Surg Res 257:69–78. 10.1016/j.jss.2020.07.060

The authors declare no competing interests.

Download PDF

Version 1

posted

You are reading this latest preprint version

Risk Factors and Outcomes of Anastomotic Failure in Combat-Related Penetrating Abdominal Trauma: A Study from Sana'a, Yemen

Status:

Version 1

Abstract

Introduction

Material and methods

Study Design and Setting

Patient Selection

Data Collection

Surgical Technique

Outcome Measures

Statistical Analysis

Results

Discussion

Conclusion

Declarations

Ethical Considerations

Informed Consent

Conflict of Interest:

Funding

Acknowledgments

Authors’ Contributions

References

Additional Declarations

Status:

Version 1