Outcomes of Hartmann's Surgery in Colonic Diverticulitis

Background Colonic diverticula are mucosal pouch anomalies extending through vulnerable areas of the colonic wall. While common in Western nations, managing complicated perforated sigmoid and rectosigmoid diverticulitis remains contentious due to high rates of abscess and peritonitis. Hartmann's surgery is commonly employed for perforated sigmoid and rectosigmoid diverticulitis due to its efficiency and the mitigation of anastomotic leakage risks. However, reversal remains challenging due to inflammatory adhesions and shortened margins. This study aims to elucidate the morbidity and mortality associated with Hartmann's operation for perforated sigmoid colon and rectosigmoid diverticula. Methodology This retrospective cohort study evaluated 96 patients diagnosed with perforated sigmoid and rectosigmoid diverticulitis who underwent open Hartmann's procedures at the Department of Digestive Surgery, Cho Ray Hospital, between May 2020 and April 2025. Demographic profiles, surgical characteristics, and 30-day postoperative complications and mortality rates were documented. Results The cohort included 50 males and 46 females with a mean age of 67.7 ± 11.4 years; 42 (43.75%) patients were over 70 years of age. Preoperative stratification that showed 60 (62.5%) patients were American Society of Anesthesiologists (ASA) Class II and 36 (37.5%) were ASA Class III. The mean postoperative stay was 7.1 ± 4.8 days, and the overall 30-day postoperative mortality rate was 20.8% (n = 20). Surgical site infections (all superficial incisional) occurred in 24% (n = 23) of cases, and postoperative pneumonia (confirmed by postoperative chest X-ray) occurred in 21.9% (n = 20). Univariate analysis showed that advanced age (>70 years) and intraoperative fecal contamination significantly increased complication risks (p = 0.015 and p = 0.026, respectively). Predictors correlating with increased mortality in univariate analysis included an admission systolic blood pressure (SBP) <90 mmHg (p < 0.001) and fecal peritonitis (p = 0.028). Mortality rates increased with disease severity, reaching 38.1% for Hinchey Grade IV, in contrast to 19.3% for Grade III and 5.6% for Grade II (p = 0.05). Multivariable logistic regression indicated that age exceeding 70 years (odds ratio (OR) = 3.085, p = 0.013) and fecal contamination (OR = 3.328, p = 0.024) were independent predictors of postoperative complications, whereas an admission SBP below 90 mmHg (OR = 16.621, p = 0.001) was the sole independent predictor of mortality. Conclusions Hartmann's procedure is an appropriate intervention for severe perforated sigmoid and rectosigmoid diverticulitis with fecal contamination of the abdominal cavity, shock, or patients with multiple comorbidities. Baseline patient factors heavily dictate survival and morbidity outcomes, with advanced age, intraoperative fecal contamination, and admission hypotension serving as critical prognostic drivers.