Restoration of digestive continuity after Hartmann's procedure

Reestablishment of colonic continuity (RDC) following Hartmann's procedure is associated with high morbidity (anastomotic leak 4-16%) and mortality (0-4%) rates. The aim of this retrospective study is to evaluate the morbidity of RDC following Hartmann's procedure, and to analyze the various factors which may be able to influence the rate of complications.

From 1996 to 2002, 74 patients were treated by Hartmann's colectomy. Of these 74 patients, 40 patients underwent a reestablishment of colonic continuity (54% of all the Hartmann's procedures). The common factor of indications is the presence of infection in the abdominal cavity, combined with a distended or prepared intestine, or both. The mean age was 60 years (33-90).

The mean delay between Hartmann's operation and the RDC was 139 days (range: 25-450 days) and 15.5 days (8-57 days) was the mean duration of the hospital stay. The mortality rate was 0% and incidence of anastomotic stricture was 2.5%. The morbidity was 45%. The majority of patients presenting complications had an ASA score of III (44.4%), and the patients without complications were for the majority classified as ASA I (45.5%)

The RDC is an intervention performed safely after a 3 to 5-month delay with an acceptable morbidity and a negligible mortality. The ASA score is a determining factor for the risk for complications (p<0.05), unlike the age. However, patients younger than 50 years benefit from a protective factor against complications.