Current indications for the Hartmann procedure

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastroenterology

Background:

• The Hartmann procedure is indicated for left-sided colonic disease, particularly emergencies where anastomosis is not feasible.
• It involves sigmoïdectomy, creating a terminal stoma, and rectal stump closure, initially for colorectal cancer.
• This approach is associated with significant mortality (15%) and morbidity (50%), with less than 50% successful reversal.

Purpose of the Study:

• To evaluate the clinical utility and outcomes of the Hartmann procedure.
• To assess the effectiveness of Hartmann procedure equivalents in colonic surgery.
• To review indications including colorectal cancer, diverticular peritonitis, and trauma.

Main Methods:

• Literature review of studies on the Hartmann procedure and its alternatives.
• Analysis of outcomes based on indications such as colorectal cancer, diverticular disease, and trauma.
• Evaluation of mortality, morbidity, and rates of subsequent stoma reversal.

Main Results:

• The Hartmann procedure is linked to high rates of mortality and morbidity.
• Subsequent restoration of intestinal continuity is achieved in less than half of the patients.
• Indications span various left-sided colonic pathologies, including cancer, diverticulitis, and trauma.

Conclusions:

• The Hartmann procedure presents significant risks and challenges regarding stoma reversal.
• Its value and alternatives require careful consideration across diverse colonic surgical indications.
• Further research may explore strategies to improve outcomes and increase reversal rates.