[Evolution of indications for Hartmann's operation. Reflexions on a series of 160 cases]

The authors report the results and indications of 160 Hartmann's procedures performed over a period of 15 years. Between 1978 and 1992, 160 patients (90 males, 70 females), with a mean age of 72, underwent Hartmann's procedure for rectosigmoid carcinoma in 55% of cases, for complications of sigmoid diverticulitis in 36% and for other lesions in 14%. Hartmann's procedure was performed either electively (42%) or as an emergency (58%) with a mortality of 6% and 32% respectively. The majority of complications included wound infections or intraperitoneal abscess, and the overall morbidity was 30%. Re-establishment of bowel continuity was performed in 30.7% of patients, most of whom had been initially operated as an emergency for a benign lesion. These 160 cases of Hartmann's procedure represent 27% of the 590 operations performed during the same period as an emergency or electively for rectosigmoid lesion. Hartmann's procedure remains a most effective technique for emergency surgery for benign or malignant lesions with colonic septic complications, and is also indicated electively for palliative treatment of rectosigmoid carcinoma.