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Hartmann procedure: is it still relevant today?
Dee Wern Seah1, Salleh Ibrahim, Khoon Hean Tay
1Department of General Surgery, Changi General Hospital, Singapore. seah.dee.wern@singhealth.com.sg
Insights
The Hartmann procedure, though less common, remains a viable option for selected left-sided colonic pathologies. This study reviews its outcomes, including morbidity and mortality rates, and reversal success.
Area of Science:
- Colorectal surgery
- Surgical procedures
- Gastrointestinal surgery
Background:
- Primary anastomosis is increasingly favored for left-sided colonic pathology.
- The Hartmann procedure is still performed regularly in some centers.
- A retrospective analysis of the Hartmann procedure's outcomes was conducted.
Purpose of the Study:
- To evaluate the outcomes of the Hartmann procedure.
- To assess the procedure's utility in selected patients.
Main Methods:
- Retrospective analysis of patient records from January 1998 to December 2001.
- Data collected included demographics, comorbidities, and indications for the procedure.
- Outcomes such as operating time, reversal rate, mortality, and morbidity were analyzed.
Main Results:
- The study included 85 patients (52 male, 33 female) with a median age of 69.
- Common indications included cancer (45) and complicated diverticulitis (19).
- First-stage mortality was 16%, morbidity 51%; reversal morbidity was 29% with a 32% reversal rate.
Conclusions:
- The Hartmann procedure remains a useful option for specific patient groups.
- Despite advances in primary anastomosis, the procedure has a role in selected cases.
Background:
With more and more centres worldwide resorting to primary anastomosis for most left sided colonic pathology, the place for a Hartmann procedure seems to be relegated to surgical history books. However, in our centre it is still being performed on a regular basis. As such, we decided to retrospectively look at our results for the procedure.
Methods:
All hospital records of patients undergoing the Hartmann procedure between January 1998 and December 2001 were retrospectively analysed looking at demographics, comorbidities and indications of the procedure.
Results:
There were 52 men and 33 women with a median age of 69 years (range 31-96 years). Sixty-six per cent of the patients had medical comorbidities at the time of the operation. The indications for performing the procedure were: 45 patients for cancer (31 patients for obstruction, 11 patients for perforation, two patients for fistulation to other organs and one for uncontrollable bleeding). 19 patients had the procedure for complicated diverticulitis while four patients had anastomotic leaks, which required conversion to the procedure. Other indications include trauma (four patients), ischemic bowel (six patients) and iatrogenic (one patient). Our median operating time was 160 min (range 50-415 min). Our reversal rate was 32%. Our mortality rate for the first stage was 16% and our morbidity, 51%. The morbidity for the reversal was 29%, with no mortalities.
Conclusion:
Though the idea of primary anastomosis with on table lavage for left sided anastomosis seems attractive, we think the Hartmann procedure is still useful for selected patients.
