Morbidity after reversal of Hartmann operation: retrospective analysis of 56 patients

Despite patient selection, postoperative morbidity after reversal of Hartmann's procedure remains significant.

The objective of this study was to investigate risk factors associated with morbidity after conversion of Hartmann's operation.

We retrospectively analyzed data of 56 patients who underwent reversal procedures between January 2004 and May 2015 in a single center. We evaluated the following variables: demographic characteristics, medical comorbidities, etiology for Hartmann operation, preoperative lab values, intraoperative surgical details and short-term outcomes (hospital stay, medical and surgical complications, mortality).

There were 37 men (66.1%) and the mean age was 57 years. The most frequent indications for Hartmann's procedure were colorectal cancer in 25 patients (44.6%) and complicated diverticulitis in 10 patients (17.9%). The mean time to the reversal procedure was 9 months. Morbidity rate was 16.1% (9 patients) with an anastomotic leakage rate of 3.6% (2 patients) and mortality rate was 3.6% (2 patients). The most common medical complication was diarrhea (4 patients, 7.2%). Bivariate analysis demonstrated that the only factor significantly associated with postoperative complications was presence of multiple comorbidities.

Multiple medical comorbidities is the only predictive factor for postoperative complications after Hartmann's reversal and therefore patient selection for this type of surgery is critical.