Hartmann's Reversal and Abdominal Wall Reconstruction: Too Risky to Combine?

Area of Science:

• Colorectal surgery
• Abdominal wall reconstruction
• Hernia surgery

Background:

• Incisional hernias are common after Hartmann's reversal (HR).
• The safety and outcomes of combining HR with incisional hernia repair (IHR) are not well-established.
• This study evaluates the feasibility and complications of concomitant HR and IHR.

Purpose of the Study:

• To assess the outcomes of simultaneous Hartmann's reversal and incisional hernia repair.
• To compare complication rates between HR alone and combined HR with IHR.

Main Methods:

• Retrospective review of 52 patients undergoing HR between 2012 and 2024.
• Patients were divided into two groups: HR alone (n=35) and concomitant HR with IHR (n=17).
• Primary outcomes included 30-day overall and major morbidity, and anastomotic leak rates.

Main Results:

• Concomitant HR and IHR (CP) had longer operative times but similar 30-day overall morbidity, major morbidity, and anastomotic leak rates compared to HR alone.
• No significant differences were found in surgical site infections, reoperation rates, or length of stay between the groups.
• No hernia recurrences were observed in the CP group during a mean follow-up of 49 months.

Conclusions:

• Concomitant HR and IHR may be feasible in carefully selected patients by experienced surgeons.
• The study's small, heterogeneous, and imbalanced cohorts necessitate further research to confirm the safety of the combined approach.