[The Hartmann type of operation].

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastroenterology

Context:

• Despite advances in surgical techniques, antibiotics, and resuscitation, Hartmann's procedure for colon resection with colostomy retains specific indications.
• This intervention is applicable for severe, extensive, and complicated colon lesions, often in patients with significant systemic deterioration.
• The procedure can be extended beyond the recto-sigmoid region and applied to various benign conditions.

Purpose:

• To evaluate the indications, outcomes, and reconstructive challenges of Hartmann's procedure in a cohort of patients with severe colon pathologies.
• To analyze the patient group undergoing colon resection with distal closure and terminal colostomy, including those with neoplastic and benign diseases.
• To investigate the feasibility and complexities of secondary restoration of bowel continuity after Hartmann's procedure.

Summary:

• A study of 28 patients (15 neoplastic, 13 benign) undergoing Hartmann's procedure revealed its use in critical conditions where other surgeries might fail.
• Resections included sigmoid, transverse, rectosigmoid, and sub-total colectomies, with some cases addressing anastomotic dehiscence.
• High postoperative mortality and septic complications were observed, consistent with the patients' critical state. Secondary transit restoration was achieved in 25% of survivors, highlighting reconstructive challenges.

Impact:

• This study underscores the continued relevance of Hartmann's procedure for complex colon resections in critically ill patients.
• It provides insights into the management of severe colon lesions and the associated postoperative complications.
• The findings highlight the technical considerations and potential difficulties in reversing the colostomy and restoring bowel continuity.