Efficacy of primary repair for retroperitoneal rectal injuries among patients with combined military trauma: tertiary single-center experience.

Background: Retroperitoneal rectal injuries (RRIs) caused by combined military trauma represent a complex clinical challenge, especially in modern armed conflicts. Traditional management protocols have evolved significantly since World War II, emphasizing fecal diversion and presacral drainage. However, emerging evidence supports primary repair as a viable alternative for select cases. This study evaluates the efficacy of primary repair for RRIs among military trauma patients treated at a tertiary center. Methods: A retrospective cohort study was conducted at the National Cancer Institute, Kyiv, Ukraine, from February 2022 to March 2024. Patients with RRIs due to combined military trauma were analyzed, excluding isolated or intraperitoneal rectal injuries. Surgical interventions included primary repair, loop sigmoidostomy, presacral drainage, and rectal washout. Postoperative outcomes were assessed, including complication rates, hospital length of stay (LOS), and mortality. Statistical analyses included χ2, Fisher's exact, t-tests, and logistic regression, with p<0.05 considered significant. Results: Twelve patients met the inclusion criteria, with a median age of 33 years (IQR 27-40). Seven patients underwent primary repair, achieving an 85.7% success rate (χ2=10.89, p=0.001). Patients receiving primary repair experienced significantly shorter LOS (55 days, IQR 44-64 140 days, IQR 99-141, p=0.048) and lower complication rates (28.5% vs 80%, p=0.079). No mortality was reported. Loop sigmoidostomy showed a 66.6% success rate, while presacral drainage and rectal washout yielded limited efficacy, particularly in severe injuries. Conclusion: Primary repair may represent a viable and promising option for managing RRIs in selected patients with combined military trauma, potentially reducing LOS and postoperative complications compared to more invasive approaches. Nevertheless, given the limited sample size (n=12), these findings should be regarded as exploratory, underscoring the need for larger, prospective studies to confirm their validity. Level of evidence: III-2 A comparative study with concurrent controls.