Reversal of Hartmann’s procedure following acute diverticulitis: is timing everything?
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Patients who undergo a Hartmann’s procedure may not be offered a reversal due to concerns over the morbidity of the second procedure. The aims of this study were to examine the morbidity post reversal of Hartmann’s procedure.
Patients who underwent a Hartmann’s procedure for acute diverticulitis (Hinchey 3 or 4) between 1995 and 2006 were studied. Clinical factors including patient comorbidities were analysed to elucidate what preoperative factors were associated with complications following reversal of Hartmann’s procedure.
One hundred and ten patients were included. Median age was 70 years and 56% of the cohort were male (n = 61). The mortality and morbidity rate for the acute presentation was 7.3% (n = 8) and 34% (n = 37) respectively. Seventy six patients (69%) underwent a reversal at a median of 7 months (range 3–22 months) post-Hartmann’s procedure. The complication rate in the reversal group was 25% (n = 18). A history of current smoking (p = 0.004), increasing time to reversal (p = 0.04) and low preoperative albumin (p = 0.003) were all associated with complications following reversal.
Reversal of Hartmann’s procedure can be offered to appropriately selected patients though with a significant (25%) morbidity rate. The identification of potential modifiable factors such as current smoking, prolonged time to reversal and low preoperative albumin may allow optimisation of such patients preoperatively.
- Rothenberger DA, Wiltz O (1993) Surgery for complicated diverticulitis. Surg Clin North Am 73:975–992
- Al-Sahaf O, Al-Azawi D, Fauzi MZ et al (2008) Early discharge policy of patients with acute colonic diverticulitis following initial CT scan. Int J Colorectal Dis 23:979–984 CrossRef
- Bannerjee S, Leather AJ, Rennie JA et al (2005) Feasibility and morbidity of reversal of Hartmann’s. Colorectal Dis 7:454–459 CrossRef
- Pearce NW, Scott SD, Karran SJ (1992) Timing and method of reversal of Hartmann’s procedure. Br J Surg 79(8):839–841 CrossRef
- Oomen JL, Cuesta MA, Engel AF (2005) Reversal of Hartmann’s procedure after surgery for complications of diverticular disease of the sigmoid colon is safe and possible in most patients. Dig Surg 22:419–425 CrossRef
- Wigmore SJ, Duthie GS, Young IE et al (1995) Restoration of intestinal continuity following Hartmann’s procedure: the Lothian experience 1987–1992. Br J Surg 82:27–30 CrossRef
- ReMine SG, Dozois RR (1981) Hartmann’s procedure—it’s use with complicated carcinomas of sigmoid colon and rectum. Arch Surg 116:630–633
- Linder MM, Wacha H, Feldmann U et al (1987) The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis. Chirug 58(2):84–92
- Lorimer JW, Doumit G (2007) Comorbidity is a major determinant of severity in acute diverticulitis. Am J Surg 193:681–685 CrossRef
- Breitenstein S, Kraus A, Hahnloser D et al (2007) Emergency left colon resection for acute perforation. Primary anastamosis or Hartmann’s procedure? A case-matched control study. World J Surg 31:2117–2124 CrossRef
- Roque-Castellano C, Marchena-Gomez J, Hemmersbach-Miller M et al (2007) Analysis of the factors related to the decision of restoring intestinal continuity after Hartmann’s procedure. Int J Colorectal Dis 22:1091–1096 CrossRef
- Sorensen LT, Hemmingsen U, Kallehave F et al (2005) Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg 241(4):654–658 CrossRef
- Kruschewski M, Rieger H, Pohlen U et al (2007) Risk factors for clinical anastamotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Colorectal Dis 22:919–927 CrossRef
- Sorensen LT, Jorgensen T (2003) Short-term smoking cessation intervention does not affect postoperative complications in colorectal surgery: a randomised clinical trial. Colorectal Dis 5:347–352 CrossRef
- Lindstrom D, Azodi OS, Wladis A et al (2008) Effects of a perioperative smoking cessation intervention on postoperative complications: a randomised trial. Ann Surg 248(5):739–745 CrossRef
- Moller AM, Villebro N, Pedersen T et al (2002) Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 359:114–117 CrossRef
- Schmelzer TM, Mostafa G, Norton J et al (2007) Reversal of Hartmann’s procedure: a high risk operation? Surgery 14294:598–607 CrossRef
- Gibbs J, Cull W, Henderson W et al (1999) Preoperative serum albumin level as a predictor of operative mortality and morbidity. Arch Surg 134:36–42 CrossRef
- Bozzetti F, Gianotti L, Braga M et al (2007) Postoperative complications in gastrointestinal cancer patients: the joint role of the nutritional status and the nutritional support. Clin Nutr 26:698–709 CrossRef
- Roe AM, Prabhu S, Ali A et al (1991) Reversal of Hartmann’s procedure: timing and operative technique. Br J Surg 78:1167–1170 CrossRef
- Regenet N, Pessaux P, Hennekinne S et al (2003) Primary anastomosis after intraoperative colonic lavage vs. Hartmann’s procedure in generalized peritonitis complicating diverticular disease of the colon. Int J Colorectal Dis 18(6):503–507 CrossRef
- Abbas S (2007) Resection and primary anastomosis in acute complicated diverticulitis, a systematic review of the literature. Int J Colorectal Dis 22(4):351–357 CrossRef
- Constantinides VA, Heriot A, Remzi F et al (2007) Operative strategies for diverticular peritonitis: a decision analysis between primary resection and anastamosis versus Hartmann’s procedures. Ann Surg 245(1):94–103 CrossRef
- Mazeh H, Greenstein AJ, Swedish K et al (2009) Laparoscopic and open reversal of Hartmann’s procedure—a comparative retrospective analysis. Surg Endosc 23(3):496–502 CrossRef
- Jamali FR, Soweid AM, Dimassi H et al (2008) Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg 143(8):762–767 CrossRef
- Reversal of Hartmann’s procedure following acute diverticulitis: is timing everything?
International Journal of Colorectal Disease
Volume 24, Issue 10 , pp 1219-1225
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