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[The Hartmann type of operation].

I Juvara, D Rădulescu, I Vereanu

    Revista De Chirurgie, Oncologie, Radiologie, O.R.L., Oftalmologie, Stomatologie. Chirurgie
    |March 1, 1980
    PubMed
    Summary

    Hartmann's procedure, a colon resection with colostomy, remains indicated for severe colon lesions despite modern advances. Reversal of this surgery presents significant technical challenges.

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    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.

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