In Reply.—This article emphasizes that (1) primary repairs of the colon do heal even in the presence of infection; and (2) most isolated injuries of the colon can be closed primarily, providing antibiotics are administered immediately after injury, during operation, and postoperatively. The primary colonic repair under these circumstances can be accomplished with or without exteriorization. The advantages of this therapeutic approach in selected cases are to reduce morbidity and length of hospitalization, and to eliminate the necessity of a secondary operation for colostomy closure. Colostomy closure in our experience has a 22% morbidity.1 We do not advocate primary repair for all colonic injuries. Our criteria for primary closure includes right-sided colonic injuries and penetrating left-sided injuries with minimal contamination of peritoneal cavity, resulting from low-velocity bullets and sharp objects such as stab wounds.
We do not advocate primary repair in colonic perforations resulting from blunt trauma, high-velocity