Reversal of Hartmann's procedure: a single‐centre experience of 533 consecutive cases

Royo-Aznar, A; Moro‐Valdezate, David; Martín-Arévalo, José; Plá-Martí, Vicente; García-Botello, Stephanie; Espín‐Basany, Eloy; Espi-Macías, Alejandro

doi:10.1111/codi.14049

Cited by 22 publications

(29 citation statements)

References 25 publications

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“…This probably reflects the technical challenges of pelvic dissection in these patients. The significance of a short rectal stump has been previously reported [12].…”

Section: Discussionmentioning

confidence: 91%

Reversal of Hartmann's procedure in patients following failed colorectal or coloanal anastomosis: an analysis of 45 consecutive cases

et al. 2019

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Aim This study aimed to assess outcomes of Hartmann's reversal (HR) after failure of previous colorectal anastomosis (CRA) or coloanal anastomosis (CAA).Methods All patients planned for HR from 1997 to 2018 following the failure of previous CRA or CAA were included.Results From 1997 to 2018, 45 HRs were planned following failed CRA or CAA performed for rectal cancer (n = 19, 42%), diverticulitis (n = 16, 36%), colon cancer (n = 4, 9%), inflammatory bowel disease (n = 2, 4%) or other aetiologies (n = 4, 9%). In two (4%) patients, HR could not be performed. HR was performed in 43/ 45 (96%) patients with stapled CRA (n = 24, 53%), delayed handsewn CAA with colonic pull-through (n = 11, 24%), standard handsewn CAA (n = 6, 14%) or stapled ileal pouch-anal anastomosis (n = 2, 4%). One (2%) patient died postoperatively. Overall postoperative morbidity rate was 44%, including 27% of patients with severe postoperative complication (Clavien-Dindo ≥ 3). After a mean follow-up of 38 AE 30 months (range 1-109), 35/45 (78%) patients presented without stoma. Multivariate analysis identified a remnant rectal stump < 7.5 cm in length as the only independent risk factor for long-term persistent stoma. Among stoma-free patients, low anterior resection syndrome (LARS) score was ≤ 20 (normal) in 43%, between 21 and 29 (minor LARS) in 33% and ≥ 30 (major LARS) in 24% of the patients.Conclusion HR can be recommended in patients following a failed CRA or CAA. It permits 78% of patients to be free of stoma. A short length of the remnant rectal stump is the only predictive factor of persistent stoma in these patients.Keywords Hartmann's reversal, redo surgery, anastomotic leakage, definitive stoma, functional resultsWhat does this paper add to the literature? This study suggests that reversal of Hartmann's procedure in patients following a failed colorectal or coloanal anastomosis permits 78% of the patients to be stoma free. A short remnant rectal stump (< 7.5 cm) was the only predictive factor of permanent stoma in these patients.

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“…This probably reflects the technical challenges of pelvic dissection in these patients. The significance of a short rectal stump has been previously reported [12].…”

Section: Discussionmentioning

confidence: 91%

Reversal of Hartmann's procedure in patients following failed colorectal or coloanal anastomosis: an analysis of 45 consecutive cases

et al. 2019

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“…Hodgson et al reported that age < 70 years was the only significant factor associated with performing HR 19 . Royo-Aznar et al reported that patients aged < 69 years were more likely to undergo HR 13 and Hess et al reported that patients aged > 76 years were less likely to receive HR 20 . Despite the differing cut-off ages, these studies consistently showed that age is a significant predictor for HR.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have suggested that patients with a lower ASA class are more likely to undergo HR, based on univariate analyses 2,[13][14][15][16]19 . Similarly, we found that patients with ASA class III/IV were less likely to undergo HR (P = 0.013).…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, we found that patients with ASA class III/IV were less likely to undergo HR (P = 0.013). The Charlson comorbidity index has also been proposed as a predictive factor for HR 13,28 . Fleming et al and Royo-Aznar et al proposed cut-off Charlson comorbidity indices of < 2 and < 6, respectively, for predicting whether HR is performed 13,28 .…”

Section: Discussionmentioning

confidence: 99%

“…The Charlson comorbidity index has also been proposed as a predictive factor for HR 13,28 . Fleming et al and Royo-Aznar et al proposed cut-off Charlson comorbidity indices of < 2 and < 6, respectively, for predicting whether HR is performed 13,28 . However, these previous studies showed that patients with a lower Charlson comorbidity index are more likely to undergo HR.…”

Section: Discussionmentioning

confidence: 99%

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

Kang

Yoon

et al. 2020

Sci Rep

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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.

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Laparoscopic and Robotic Hartmann’s Reversal: Strategies to Avoid Complications

Kleiman

Lee-Kong

2019

The SAGES Manual of Colorectal Surgery

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Reversal of Hartmann's procedure: a single‐centre experience of 533 consecutive cases

Abstract: Age, ASA grade, the indication for HP, the length of rectal stump, anal incontinence, tumour stage, postoperative transfusion and elective surgery determine the probability of reversal.

Cited by 22 publications

References 25 publications

Reversal of Hartmann's procedure in patients following failed colorectal or coloanal anastomosis: an analysis of 45 consecutive cases

Reversal of Hartmann's procedure in patients following failed colorectal or coloanal anastomosis: an analysis of 45 consecutive cases

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

Laparoscopic and Robotic Hartmann’s Reversal: Strategies to Avoid Complications

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