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