Reversal of Hartmann's procedure: The impact of timing - a single-tertiary-center experience

The optimal timing for Hartmann's reversal remains a topic of ongoing debate. This study aimed to assess postoperative outcomes in patients undergoing early versus late Hartmann's reversal at a tertiary academic center in Germany.

A single-center retrospective cohort study was conducted, including all patients who underwent Hartmann's reversal between January 2008 and July 2020. Patients were stratified into early (ER) and late (LR) reversal groups using a median cut-off value of 159 days. Operative outcomes including major morbidity and overall postoperative complications were compared between both groups. Factors associated with major postoperative morbidity were detected using uni- and multivariate regression models.

A total of 133 patients classified into the ER (n = 67, 50.38%) and LR (n = 66, 49.62%) groups were analyzed. There were no significant differences in overall morbidity (ER 56.72% versus LR 39.39%, p = 0.057) and major morbidity rates (Clavien-Dindo ≥ IIIa) (ER 28.36% versus LR 21.21%, p = 0.423) between both groups. On multivariate analysis, smoking (p = 0.006), chronic renal disease (p = 0.003) and anastomotic configuration (p = 0.003) were identified as significant factors contributing to major morbidity after Hartmann's reversal.

Hartmann's reversal is still associated with an increased risk of postoperative complications. However, timing of Hartmann's reversal does not seem to influence postoperative morbidity. Of note, patient-related modifiable factors as well as the anastomotic configuration are important determinants of major complication occurrence.