Repair of full-thickness bowel injury

OBJECTIVEColon surgery is more and more often performed in complex situations such as after trauma, under immunosuppression, or in the elderly. Even under optimal conditions, anastomosis fails in certain situations. The objective of this study was to demonstrate the normal phases of bowel healing and to review the local and systemic factors affecting healing with special attention to critical care variables such as major surgery, acute hemorrhage, and infections. DATA SOURCEMEDLINE cited and/or published articles. DESIGNReview analysis. RESULTSColon healing is a structured cascade of different phases that can be affected by a multitude of local (infection, ischemia) and systemic (diabetes, malnutrition, anemia, hypothermia, trauma) factors. The normal phases of repair, the resulting bursting pressure as an experimental index of healing, and the available published data on local and systemic factors affecting healing are summarized. CONCLUSIONSeveral local and systemic factors negatively affect bowel healing; there is still a small portion of patients who fail to heal, suggesting that intrinsic factors need to be analyzed.