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HARTMANN'S PROCEDURE REVISITED
R P Choubey1, P K Patnaik1, A K Sharma2
1Classified Specialist Surgery & Gastrointestinal Surgery, Command Hospital, (Central Command) Lucknow.
Insights
Hartmann's procedure is a safe and effective surgical option for colorectal pathologies. Reestablishing bowel continuity in a second stage significantly reduces complications and mortality.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Gastrointestinal Procedures
Background:
- Hartmann's procedure is utilized for various colorectal conditions.
- Assessing the safety and efficacy of Hartmann's procedure is crucial for patient outcomes.
- Previous literature suggests potential risks associated with primary anastomosis in certain colorectal surgeries.
Purpose of the Study:
- To evaluate the utility, safety, and effectiveness of Hartmann's procedure in patients undergoing colonic surgery.
- To compare complication and mortality rates between the initial Hartmann's procedure and subsequent reversal surgery.
Main Methods:
- Retrospective analysis of 63 patients who underwent Hartmann's procedure between July 1991 and June 1999.
- Data collected included patient demographics, surgical outcomes, mortality, and complication rates.
- Comparison of outcomes for the initial procedure versus the second stage (reestablishing bowel continuity).
Main Results:
- The overall mortality for the initial Hartmann's procedure was 12.7%.
- In 47 patients where bowel continuity was reestablished in a second stage, mortality was nil.
- Complication rates were significantly lower in the second stage operation compared to the first.
Conclusions:
- Hartmann's procedure is a safe and effective surgical approach for managing colorectal pathologies.
- Resection and primary anastomosis in certain colorectal conditions carry higher risks.
- Staged approach with Hartmann's procedure followed by reversal offers improved safety and reduced complications.
Abstract:
Between July 1991 and June 1999 out of 176 patients undergoing colonic surgery (elective and emergency), Hartmann's procedure was performed in 63. There were 39 males and 24 females. Mean age was 43 years (range 12 to 81). To assess the utility of Hartmann's procedure the documents of all these 63 patients were retrospectively analysed. In 47 bowel continuity was reestablished. The over all mortality in first stage operation (Hartmann's procedure) was 12.7% and mortality in the second stage procedure (reestablishing bowel continuity) was nil. Complication rate was drastically less in second operation. The authors conclude that Hartmann's procedure is safe and effective while dealing with colorectal pathologies as resection and primary anastomosis is fraught with danger.
