Quality of Life After Hartmann's and Reversal of Hartmann's Procedure

Hartmann's procedure is widely performed for colorectal emergencies, with reversal typically considered within 6-12 months to restore intestinal continuity. However, the decision to undergo reversal remains complex, requiring a balance between surgical risks and benefits. Despite its prevalence, limited research directly compares quality of life (QoL) outcomes between patients who only undergo Hartmann's procedure and those who proceed with reversal.

This single-centre study included 91 patients (50 post-Hartmann's, 41 post-reversal). Participants were asked to complete the Colorectal Surgery Quality of Life Questionnaire 1 year after surgery. This 35-item questionnaire includes the Low Anterior Resection Syndrome score alongside questions assessing patients' physical wellbeing, sexual function, daily life impact, and attitude towards a stoma.

Patients who underwent Hartmann's reversal reported significantly better postoperative work productivity (p = 0.046) and physical wellbeing (p < 0.001) compared to those who only had the Hartmann's procedure. Reversal was also associated with better postoperative sexual function (p = 0.005) after adjusting for age and sex. Within the reversal cohort, however, a small subset (n = 7, 17%) developed Low Anterior Resection Syndrome (LARS) and appeared to report poorer physical wellbeing (p < 0.001) and sexual function (p < 0.001). Although most patients preferred not to have a stoma, those with LARS in our study were more likely to favour retaining one (p < 0.001).

This study offers valuable insights into the QoL outcomes of Hartmann's procedure and its reversal, highlighting the importance of preoperative counselling, particularly regarding the potential for LARS in patients considering reversal surgery.