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Subtotal colectomy with Hartmann's pouch for inflammatory bowel disease
L A Karch1, J J Bauer, S R Gorfine
1Department of Surgery, Mount Sinai School of Medicine, City University of New York, New York, USA.
Diseases of the Colon and Rectum
|June 1, 1995
Summary
Intraperitoneal Hartmann's closure is a safe and effective rectal remnant management after subtotal colectomy for inflammatory bowel disease (IBD) colitis. Routine transanal catheter drainage significantly reduced complications like pelvic sepsis.
Area of Science:
- Gastroenterology
- Colorectal Surgery
Background:
- Inflammatory bowel disease (IBD) colitis management often requires subtotal colectomy (STC).
- Optimal handling of the rectal remnant after STC remains a subject of debate.
- Intraperitoneal Hartmann's closure is one method for managing the rectal stump.
Purpose of the Study:
- To evaluate the safety and efficacy of intraperitoneal Hartmann's closure for rectal remnant management in IBD colitis patients undergoing STC.
- To assess the incidence of complications associated with this surgical technique.
Main Methods:
- Retrospective review of 114 IBD colitis patients who underwent STC with Hartmann's pouch since 1988.
- Analysis of patient demographics, operative details, and postoperative complications.
- Documentation of technical difficulties and complications in patients requiring subsequent surgery.
Main Results:
- A 2.6% incidence of pelvic sepsis occurred due to Hartmann's pouch leakage in the initial cohort.
- Implementing routine transanal catheter drainage for the rectal remnant eliminated leakage in 41 subsequent patients.
- A 3% rate of technical difficulty was noted in mobilizing the rectal remnant during subsequent procedures.
Conclusions:
- Intraperitoneal Hartmann's closure is a preferred method for rectal remnant management in patients with severe IBD colitis undergoing STC.
- Routine transanal catheter drainage is a valuable adjunct for preventing complications associated with Hartmann's closure.