Hartmann's Reversal is More Complex Than Elective Left Colectomy

Area of Science:

• Colorectal surgery
• Surgical outcomes research
• Patient risk stratification

Background:

• Hartmann's reversal (HR) presents significant technical challenges and morbidity.
• A substantial proportion of patients with colostomies do not undergo reversal.
• Objective comparison of HR versus elective left colectomy (LC) is needed to guide clinical decisions.

Purpose of the Study:

• To compare the surgical risks and outcomes of Hartmann's reversal (HR) against elective left colectomy (LC).
• To provide data to aid surgeons and patients in the complex decision-making process regarding HR.

Main Methods:

• Retrospective analysis of a prospective database from a tertiary medical center.
• Inclusion of patients undergoing elective HR or LC between January 2014 and November 2021.
• Comparison of preoperative variables, intraoperative events, and short-term postoperative outcomes.

Main Results:

• 135 patients (30 HR, 105 LC) were analyzed with no significant demographic or comorbidity differences.
• HR cases involved more open and fewer robotic procedures, with longer operative times.
• HR was associated with higher rates of intraoperative complications (13.3% vs 1.9%) and minor postoperative complications (46.7% vs 26.7%).
• Time to first flatus/bowel movement was significantly longer after HR (3.6 vs 2.5 days).

Conclusions:

• Hartmann's reversal is a more technically demanding procedure than elective left colectomy.
• HR is associated with increased intraoperative and minor postoperative complication rates.
• Future research should focus on strategies to mitigate risks and improve outcomes for HR patients.