Analysis of factors affecting reversal of Hartmann’s procedure and post-reversal complications

Abstract

Although Hartmann’s procedure (HP) is commonly used as emergency treatment for colorectal disease, the reversal of HP (HR) is infrequently performed. The aims were to evaluate the rate of HR and determine the factors predictive of achieving HR. We retrospectively reviewed the medical records of patients who underwent HP between January 2007 and June 2019 at six Hallym University-affiliated hospitals. Multivariable analysis was performed to identify which factors were independently associated with HR. In the study period, 437 patients underwent HP, and 127 (29.0%) subsequently underwent HR. Of these, 46 (35.9%) patients experienced post-HR complications. In multivariable analysis, an interval between HP and HR of > 6 months was associated with the only lower rate of post-HR complications. Multivariate analysis showed that HR was less likely in patients aged > 70 years, those with American Society of Anesthesiologists (ASA) class III or IV, elective surgery, those experiencing more than two HP-related complications, and those with a malignancy (an indication for HP). One-third of the patients underwent HR. Age > 70 years, ASA class III or IV, elective surgery, more than two HP-related complications, and malignancy were associated with a non-HR rate.

Hartmann's Reversal Through Transanal Hand-Sewn Anastomosis With Rectal Mucosectomy for a Challenging Case: Case Report

“…2 The rate of complications after Hartman's reversal is high at 22.9% to 68.5%, and the mortality rate is also high at 4.7%. 3 In many cases, the reversal was avoided, or the stoma had to be reconstructed after the reversal attempt, leading to a permanent stoma. 2,5 Factors to the increased difficulty of the operation include a short rectal stump, rectal stump atrophy, and rigid dense pelvic adhesion.…”

“…2 However, Hartmann's reversal has a high morbidity rate of 22.9% to 68.5% and a mortality rate of 0% to 4.7%. 3 In particular, dense adhesions due to a previous surgery or a short rectal stump increase the difficulty of the operation and frequency of complications. 1,2,4 When a fistula develops as a complication, the stoma needs to be reestablished, compromising the quality of life of patients.…”

Management of obstructive colon cancer: Current status, obstacles, and future directions

“…A significant number of patients end up with temporary or permanent stoma after emergency surgery. Furthermore, subsequent surgery for stoma reversal is associated with a high morbidity rate of 21% to 36%[ 24 , 25 ]. Up to 71% of patients never undergo surgery for stoma reversal, significantly affecting the quality of life[ 25 , 26 ].…”

“…Furthermore, subsequent surgery for stoma reversal is associated with a high morbidity rate of 21% to 36%[ 24 , 25 ]. Up to 71% of patients never undergo surgery for stoma reversal, significantly affecting the quality of life[ 25 , 26 ]. The risk factors related to nonreversal of the stoma include advanced age, a postoperative complication that occurred after emergency surgery, comorbidity, and advanced cancer stage[ 24 , 26 ].…”

Is Closure of Hartmann’s Colostomy a Safe Operation?

“…3 In addition, this technique is frequently preferred in cases of complicated diverticulitis, sigmoid volvulus or colon trauma. 4 Hartmann's procedure is a surgical method used not only in urgent surgery or damage control surgery, but also in patients with comorbidities to reduce operation time and to prevent complications due to anastomosis. 5 Although it is preferred to attempt primary anastomosis in colon resections as often as possible, since it will eliminate the need for surgery, the presence of panperitonitis or patient comorbidities may make it necessary to apply Hartmann's procedure, especially in emergency conditions and in cases where preoperative preparation is not sufficient.…”