Hartmann Procedure Revisited

Khosraviani, Kourosh; Campbell, W. J.; Parks, Thomas G.; Irwin, S. T.

doi:10.1080/110241500447272

Cited by 51 publications

(43 citation statements)

References 9 publications

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“…Waiting for maturation of scar tissue and adhesions, physiological improvement of a patient and adequate treatment of the primary condition would, however, seem sensible before reversal is undertaken. Most patients undergo reversal between 7 and 8 months [11,13,[24][25][26]. Very few are reversed <6 months after the original procedure [27,28].…”

Section: Discussionmentioning

confidence: 99%

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Use of Hartmann’s procedure in England

et al. 2009

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Section: Discussionmentioning

confidence: 99%

“…Such reports are usually from a single centre [10][11][12] or city [13]. This study analyses the use of Hartmann's operation among all hospitals in England during a 1-year period and its subsequent reversal over a further 4-year period.…”

Section: Introductionmentioning

confidence: 99%

Use of Hartmann’s procedure in England

et al. 2009

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“…Despite the improvement in surgical technique and antimicrobial therapies during recent decades, Hartmann's procedure is still a surgical option worldwide for patients of older age, poor physical status, and with severe abdominal sepsis [11,12]. It is generally agreed that the advantage of this procedure is to offer a relatively short operating time, simpler technique, removal of the septic source, and avoidance of an anastomosis in an unprepared, inflamed, edematous bowel, and to reserve a possibility of restoring intestinal continuity in the future.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Clinical Parameters Influencing Surgical Mortality and the Reversal of Hartmann’s Procedure

Chen

Hsiao

et al. 2008

Chir Gastroenterol

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Background: The purpose of this study was to examine our experience with Hartmann’s procedure including the reversal rate and the results of the second-stage operation for restoration of intestinal continuity. Variables that might be associated with the mortality of Hartmann’s procedure and influence the decision making regarding the reversal operation were also analyzed. Patients and Methods: We retrospectively reviewed medical records of 151 consecutive patients who underwent Hartmann’s procedure between 1998 and 2005 in our institution. Charts were reviewed for demographics, surgical indications, complications, mortality, reversal rate, and the results of the reversal operation. Results: There were 95 male and 56 female patients, with a mean age of 64.9 years. All patients underwent Hartmann’s procedure for left-sided colonic pathology. Left-sided colonic cancer (40.4%) and complicated diverticular diseases (23.8%) were the most frequent indications. Complications occurred in 44 patients (29.1%), and the mortality rate was 11.9% (18/151). Comorbidity (≧2) was the only predisposing factor for an increased mortality (p = 0.006). A total of 88 patients (66.2%) underwent the reversal procedure. The median interval between the initial operation and the second procedure was 107.8 days. The complication rate was 13.6% (12/88), with no serious complications such as anastomotic dehiscence noted. No deaths occurred in this group. Advanced age (p = 0.038), comorbid disease (p < 0.01), and malignancy (p < 0.01) were associated with significantly lower rates of colostomy reversal. Conclusion: Hartmann’s procedure remains valuable in patients with a life-threatening left-sided colonic disease with acceptable morbidity and mortality. Especially in younger patients, patients with benign abdominal pathology, and patients with fewer comorbid diseases, the second-stage operation for restoration of colonic continuity is safe, and associated with minimal mortality and morbidity.

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“…Expenditure for several operations and the rate of complications are higher than for one-stage resection. Since complications occur in up to 40% of patients treated for cancer of the left colon with obstruction and the postoperative mortality rate is 10-30% [2,5,6], it is very important to look for better treatment options. Although there are many publications [7,8,40,41] describing excellent CLCO treatment results after resection using Dudley's method of on-table wash-out of the colon [9] to permit primary anastomosis, surgeons still use a great variety of treatment options [10].…”

Section: Introductionmentioning

confidence: 99%

One-Stage Operation for Cancer of the Left Colon with Bowel Obstruction: Do We Need On-Table Wash-Out of the Colon?

et al. 2006

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Background: Cancer of the left colon with obstruction (CLCO) is a serious disease. Many surgeons perform one-stage resection with the on-table wash-out of the colon. However, there is uncertainty concerning the necessity of wash-out and absolute clearness of the colon. Our goal was to clarify that. Patients and Methods: The data of 108 patients urgently operated due to CLCO from 1996 to 2005 were analyzed retrospectively and prospectively. Results: On-table wash-out was performed in 59 patients, and 49 patients were without it. Both groups were similar by age, gender, tumor site, and extent of operation. The rate of complications in the first and the second group was 30.5 and 28.6%, respectively. Suture leakage was observed in 8.5% of patients in the first group and 4.1% in the second group (total 6.5%). Most frequently, leakage was observed in cases of resection of the rectum (18.9%) (p = 0.04). The type of suture did not have any significant impact on the occurrence of leakages (p > 0.05). Intraoperative wash-out prolonged the duration of operation by 33.2 min (p < 0.001). The postoperative mortality rate in the first and the second group was 3.39% and 6.1%, respectively; (total 4.64%). Only 1 patient died due to the complications caused by suture leakage. Conclusion: One-stage surgery due to CLCO is safe, and intraoperative wash-out is not necessary.

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Hartmann Procedure Revisited

Abstract: Hartmann's procedure remains a safe and suitable option in patients with left sided colonic emergencies.

Cited by 51 publications

References 9 publications

Use of Hartmann’s procedure in England

Use of Hartmann’s procedure in England

Evaluation of Clinical Parameters Influencing Surgical Mortality and the Reversal of Hartmann’s Procedure

One-Stage Operation for Cancer of the Left Colon with Bowel Obstruction: Do We Need On-Table Wash-Out of the Colon?

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Hartmann Procedure Revisited

Abstract: Hartmann's procedure remains a safe and suitable option in patients with left sided colonic emergencies.

Cited by 51 publications

References 9 publications

Use of Hartmann’s procedure in England

Use of Hartmann’s procedure in England

Evaluation of Clinical Parameters Influencing Surgical Mortality and the Reversal of Hartmann&rsquo;s Procedure

One-Stage Operation for Cancer of the Left Colon with Bowel Obstruction: Do We Need On-Table Wash-Out of the Colon?

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Evaluation of Clinical Parameters Influencing Surgical Mortality and the Reversal of Hartmann’s Procedure