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Hartmann procedure revisited
K Khosraviani1, W J Campbell, T G Parks
1Coloproctology Unit, Royal Victoria Hospital, Belfast, Northern Ireland.
Insights
Hartmann's procedure for left-sided colonic disease has acceptable outcomes, with a 10% mortality rate. Restoration of bowel continuity is feasible in most surviving patients, offering a safe surgical option.
Area of Science:
- Colorectal surgery
- Surgical outcomes
- Gastrointestinal disease
Background:
- Hartmann's procedure is a common surgical intervention for left-sided colonic disease.
- Restoration of bowel continuity after Hartmann's procedure is a significant consideration for patient management.
Purpose of the Study:
- To evaluate the complications and outcomes of Hartmann's procedure.
- To assess the success rate of secondary restoration of continuity following the procedure for left-sided colonic disease.
Main Methods:
- Retrospective study of 72 patients undergoing Hartmann's procedure between 1985 and 1998.
- Analysis of emergency versus elective procedures, indications, mortality, morbidity, and stoma reversal rates.
Main Results:
- Overall postoperative mortality was 10% (7/72), with similar rates for emergency and elective cases.
- Complications occurred in 43% of patients, including 11% with wound infections.
- 70% (30/43) of suitable patients had successful restoration of bowel continuity with no postoperative deaths or anastomotic dehiscence.
Conclusions:
- Hartmann's procedure is a safe and effective option for left-sided colonic emergencies.
- Secondary restoration of continuity is achievable and safe in selected patients.
Objective:
To assess the complications and results of Hartmann's procedure and secondary restoration of continuity for left-sided colonic disease.
Design:
Retrospective study.
Setting:
University hospitals, Northern Ireland.
Subjects:
72 Patients who required a Hartmann's procedure over a 13 year period (1985-1998).
Intervention:
Of these 45 (63%) were done as emergencies and 27 (38%) as elective procedures. The indications for an emergency procedure were obstruction and perforation.
Main Outcome Measures:
Mortality, morbidity, reversal of stoma rate.
Results:
The overall postoperative mortality was 7/72 (10%), with no significant difference between the emergency (4/45, 9%) and the elective (3/27, 11%) groups. Postoperative complications occurred in 31 patients (43%), and 8 developed wound infections (11%). Of the 43 surviving patients who where deemed suitable for re-establishment of continuity, 30 (70%) have had it done. There were no postoperative deaths or anastomotic dehiscences after the restoration of continuity.
Conclusion:
Hartmann's procedure remains a safe and suitable option in patients with left sided colonic emergencies.
