[Hartmann 's procedure. A 30 years one-centre clinical experience]

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastroenterology

Context:

• The Hartmann's procedure, described in 1921, is a surgical option for rectosigmoid neoplasma when primary anastomosis is not feasible.
• This study reviews a 30-year single-center experience with 221 patients undergoing this procedure.

Purpose:

• To analyze the surgical indications, technique, and outcomes of Hartmann's procedure over three decades.
• To evaluate the efficacy of a trans-anastomotic tube in enhancing the safety of re-anastomosis after Hartmann's procedure.

Summary:

• A cohort of 221 patients underwent Hartmann's procedure between 1977 and 2007, with the most recent series including 65 patients (2000-2007) primarily for malignant rectal and colon tumors.
• Favorable outcomes were observed in 49 patients, with 13 experiencing complications and 3 mortality. Reversal was possible in 24 patients.
• The use of a trans-anastomotic tube was implemented to facilitate safe re-anastomosis, potentially obviating the need for protective ileostomy or colostomy.

Impact:

• Provides long-term clinical data on the Hartmann's procedure, contributing to evidence-based surgical decision-making.
• Highlights the utility of trans-anastomotic tubes as a method to improve safety and potentially reduce ostomy rates in colorectal surgery.
• Offers insights into complication rates and the feasibility of reversal, informing patient counseling and surgical planning.