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Hartmann resection for perforated sigmoid diverticulitis. A retrospective study of the Vancouver General Hospital
Insights
Management of perforated sigmoid diverticulitis using Hartmann resection showed a 2.6% mortality. Creating a distal mucous fistula may simplify colostomy closure and improve outcomes for patients undergoing this surgery.
Area of Science:
- Colorectal Surgery
- Gastrointestinal Surgery
- Surgical Outcomes
Background:
- Perforated sigmoid diverticulitis presents significant surgical challenges.
- The Hartmann resection is a common approach for managing this condition.
Purpose of the Study:
- To retrospectively analyze the outcomes of Hartmann resection for perforated sigmoid diverticulitis.
- To evaluate the efficacy of modified Hartmann resection with a distal mucous fistula.
Main Methods:
- Retrospective review of 78 patients treated at Vancouver General Hospital over 15 years.
- Analysis of surgical procedures, complications, and mortality rates.
- Comparison between classic and modified Hartmann resections.
Main Results:
- Hartmann resection was performed in 78 patients; 63 classic, 15 modified (19.2%).
- Hemorrhage occurred in 37.2%; wound infection rate was 24.4%.
- Mortality was 2.6% (2 deaths); 9% required a second operation for complications.
Conclusions:
- Modified Hartmann resection with a distal mucous fistula may facilitate easier colostomy closure.
- Minimal resection of the distal segment is recommended when feasible.
- Careful surgical technique is crucial to minimize complications like hemorrhage and infection.
Abstract:
The results of management of perforated sigmoid diverticulitis were studied retrospectively at Vancouver General Hospital over a 15-year period. The Hartmann resection (or a modification) was the surgical procedure used. A classic Hartmann resection was performed in 63 of 78 patients, i.e., following removal of the distal segment, the rectal stump was closed. A modified Hartmann resection was performed in 15 patients (19.2 per cent), where a distal mucous fistula was created to facilitate subsequent colostomy closure. Hemorrhage was a common problem during the procedure (37.2 per cent) and other organ injury was uncommon. The wound infection rate was 24.4 per cent. Nine per cent of patients required a second operation for treating postoperative complications. Two of the patients died; the mortality was 2.6 per cent. Recommendations include the creation of a distal mucous fistula when possible. Minimal resection of the distal segment may often permit this and will allow easier closure of the colostomy.