Hartmann’s reversal: factors affecting complications and outcomes

Whitney, Stewart; Gross, Benjamin D.; Mui, Alex; Hahn, Sue J; Read, Blake; Bauer, Joel J.

doi:10.1007/s00384-020-03653-4

Cited by 15 publications

(9 citation statements)

References 18 publications

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“…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 ].…”

Section: Treatments and Their Outcomesmentioning

confidence: 99%

“…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 ]. Although the operative approach with primary tumor resection with end stoma is considered the safest option due to the absence of anastomotic complications[ 20 ], the two-stage operation is complex and may significantly reduce patient quality of life.…”

Section: Treatments and Their Outcomesmentioning

confidence: 99%

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

Yoo¹,

Cho²,

Kye³

2021

WJGO

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Approximately 10%–18% of patients with colon cancer present with obstruction at the initial diagnosis. Despite active screening efforts, the incidence of obstructive colon cancer remains stable. Traditionally, emergency surgery has been indicated to treat patients with obstructive colon cancer. However, compared to patients undergoing elective surgery, the morbidity and mortality rates of patients requiring emergency surgery for obstructive colon cancer are high. With the advancement of colonoscopic techniques and equipment, a self-expandable metal stent (SEMS) was introduced to relieve obstructive symptoms, allowing the patient’s general condition to be restored and for them undergo elective surgery. As the use of SEMS placement is growing, controversies about its application in potentially curable diseases have been raised. In this review, the short- and long-term outcomes of different treatment strategies, particularly emergency surgery vs SEMS placement followed by elective surgery in resectable, locally advanced obstructive colon cancer, are described based on the location of the obstructive cancer lesion. Controversies regarding each treatment strategy are discussed. To overcome current obstacles, a potential diagnostic method using circulating tumor DNA and further research directions incorporating neoadjuvant chemotherapy are introduced.

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Section: Treatments and Their Outcomesmentioning

confidence: 99%

Section: Treatments and Their Outcomesmentioning

confidence: 99%

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

Yoo¹,

Cho²,

Kye³

2021

WJGO

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Section: Hemodynamically Stablementioning

confidence: 99%

“…Recent evidence suggests that the HP should only be indicated in severe generalized peritonitis or in critically ill patients [ 49 ], due to the high rate of permanent colostomy [ 50 ], poor quality of life [ 51 , 52 ] and higher rate of post-operative complications associated with the Hartmann’s reversal [ 53 ]. In selected patients (i.e., those with severe local inflammation), PRA with diverting loop ileostomy can represent an alternative to HP with a reduced risk of anastomotic leak and related complications [ 26 ].…”

Section: Indications For Non-operative Treatment or Surgerymentioning

confidence: 99%

State-of-the-art surgery for sigmoid diverticulitis

Cirocchi

Sapienza

Anania

et al. 2021

Langenbecks Arch Surg

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Summary Background In the last two decades, there has been a Copernican revolution in the decision-making for the treatment of Diverticular Disease. Purpose This article provides a report on the state-of-the-art of surgery for sigmoid diverticulitis. Conclusion Acute diverticulitis is the most common reason for colonic resection after cancer; in the last decade, the indication for surgical resection has become more and more infrequent also in emergency. Currently, emergency surgery is seldom indicated, mostly for severe abdominal infective complications. Nowadays, uncomplicated diverticulitis is the most frequent presentation of diverticular disease and it is usually approached with a conservative medical treatment. Non-Operative Management may be considered also for complicated diverticulitis with abdominal abscess. At present, there is consensus among experts that the hemodynamic response to the initial fluid resuscitation should guide the emergency surgical approach to patients with severe sepsis or septic shock. In hemodynamically stable patients, a laparoscopic approach is the first choice, and surgeons with advanced laparoscopic skills report advantages in terms of lower postoperative complication rates. At the moment, the so-called Hartmann’s procedure is only indicated in severe generalized peritonitis with metabolic derangement or in severely ill patients. Some authors suggested laparoscopic peritoneal lavage as a bridge to surgery or also as a definitive treatment without colonic resection in selected patients. In case of hemodynamic instability not responding to fluid resuscitation, an initial damage control surgery seems to be more attractive than a Hartmann’s procedure, and it is associated with a high rate of primary anastomosis.

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“…In the absence of established guidelines, the decision whether to restore bowel continuity arises from the consensus between the surgeon and the patient after discussion on the possible benefits and risks associated with the procedure. In this perspective, young age, low American Society of Anesthesiologists (ASA) score, low comorbidity, benign disease, male gender, and high-volume surgeons are factors associated both with a better peri-operative outcome and a higher reversal rate [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Scientific data, focused on the effect of time from the initial procedure up to the restoration on early and late outcomes, are still lacking.…”

Section: Introductionmentioning

confidence: 99%

Colostomy Reversal following Hartmann’s Procedure: The Importance of Timing in Short- and Long-Term Complications: A Retrospective Multicentric Study

Clementi

Pietroletti

Carletti

et al. 2022

JCM

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The restoration of bowel continuity following Hartmann’s Procedure (HP) has been reported hitherto with high morbidity and mortality rates. No clear guidelines exist about timing in Hartmann’s Reversal (HR), the literature data being conflicting. We have sought to investigate the effect of the interval time between HP and HR in short- and long-term HR outcomes through a retrospective study based on consecutive patients undergoing HR between 2009 and 2017 in two regional hospitals in Italy. Demographic characteristics, comorbidities, intra- and post-operative data, as well as early complications, were recorded. Long-term data were collected on the surgical site occurrences of Incisional Ventral Hernia (IVH). One hundred and five patients were recruited for the study. Late HR, female gender, and long operating time were related to the highest incidence of peri-operative complications. Patients who developed IVH had undergone HR at significantly shorter times and had a higher Body Mass Index (BMI). The timing of HR seems to be an important variable linked to the onset of early and late post-operative complications. The patients submitted to early HR show a significantly lower complication rate but, at the same time, a higher rate of IVH incidence after restorative surgery. These data, in our opinion, reflect the need for planning, where possible, an early restoration of bowel continuity after HP.

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Hartmann’s reversal: factors affecting complications and outcomes

Cited by 15 publications

References 18 publications

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

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

State-of-the-art surgery for sigmoid diverticulitis

Colostomy Reversal following Hartmann’s Procedure: The Importance of Timing in Short- and Long-Term Complications: A Retrospective Multicentric Study

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