Reversal of Hartmann's procedure: Timing and operative technique

Abstract

A review of closure of Hartmann's colostomy was undertaken to establish guidelines for the timing and technique of reversal. Between 1984 and 1990 there were 69 reversals; 48 patients originally had diverticular disease and 21 had carcinoma. One-third underwent reversal before 4 months and two-thirds after this time. The operative mortality rate was 3 per cent and the anastomotic leak rate 4 per cent. Significant morbidity occurred in 30 per cent. There was no advantage in delayed closure. Complications occurred in 24 per cent of patients undergoing reversal before and 35 per cent undergoing reversal after 4 months. Thirty-five anastomoses were hand-sewn and 34 stapled. There were no differences in operating time for the two techniques, but a greater number were stapled after 4 months than before (P less than 0.05), which may reflect increased rectal stump shrinkage with time. There were no differences in complication rates whether the anastomosis was hand-sewn (34 per cent) or stapled (26 per cent). Closure of Hartmann's colostomy is a safe procedure but has a significant morbidity in nearly one-third of cases. On the basis of these results, there is no indication to delay closure after 4 months have elapsed, and earlier reversal, when the rectal stump is most accessible, is recommended.

Laparoscopic colostomy reversal after a Hartmann procedure: a prospective series, literature review and an argument against laparotomy as the primary approach

“…In our series of 28 patients, intra-and postoperative adverse events (3.6% and 10.7%, respectively) compared favourably with that reported in the open surgery (13%-50%) [1][2][3][4][5] and laparoscopic surgery (9%-25%) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] literature for reversal of a Hartmann procedure. No clinical leaks were encountered, and there was no mortality.…”

“…Open restoration of bowel continuity can be easier but appears to be associated with significant morbidity and mortality. [1][2][3][4][5] A review of the literature reveals that only a few small …”

“…Il y a eu O pen restoration of bowel continuity after a Hartmann procedure is technically challenging and has been associated with significant morbidity (13%-50%), including anastomotic leakage (0%-15%), incisional hernia and wound infections. [1][2][3][4][5] The mortality rate for the open approach remains high at 5%-10%. [1][2][3][4] Because of the relatively high morbidity and mortality rates and associated patient comorbidities, up to 60% of patients never have intestinal continuity re-established.…”

“…[1][2][3][4][5] The mortality rate for the open approach remains high at 5%-10%. [1][2][3][4] Because of the relatively high morbidity and mortality rates and associated patient comorbidities, up to 60% of patients never have intestinal continuity re-established. 1,2 Few studies have examined the role of laparoscopy in performing colostomy reversal after a Hartmann procedure since it was initially reported in 1993.…”

Use of Hartmann’s procedure in England

“…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.…”