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The utility of the Hartmann procedure
D C Desai1, E J Brennan, J F Reilly
1Department of Surgery, Lankenau Hospital, Wynnewood, Pennsylvania, 19096, USA.
American Journal of Surgery
|March 27, 1998
Summary
The Hartmann procedure is a safe surgical option for rectosigmoid conditions. This study shows acceptable morbidity and mortality, with a low-risk second stage for bowel restoration.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Gastroenterology
Background:
- The Hartmann procedure, described in 1923 for rectosigmoid cancer, has expanded indications.
- It is now used for complicated diverticulitis, ischemic bowel, perforations, volvulus, and colitis.
Purpose of the Study:
- To evaluate the outcomes of the Hartmann procedure.
- To assess indications, morbidity, mortality, and the success of the second-stage operation.
Main Methods:
- Retrospective review of 185 patients undergoing the Hartmann procedure (1981-1995).
- Analysis of patient charts for indications, complications, and mortality.
Main Results:
- Complicated diverticulitis (108 patients) and rectosigmoid cancer (31 patients) were primary indications.
- In-hospital mortality was 14% (27 deaths), with overall complications <9%.
- Of 158 survivors, 57% had a second stage with no mortality and <4% complications.
Conclusions:
- This series demonstrates lower mortality than other reports.
- The second stage is safe with minimal morbidity and no mortality in selected patients.
- The Hartmann procedure is a safe and effective option for complex rectosigmoid pathology.