International Journal of Colorectal Disease

, Volume 22, Issue 9, pp 1091–1096 | Cite as

Analysis of the factors related to the decision of restoring intestinal continuity after Hartmann’s procedure

  • Cristina Roque-Castellano
  • Joaquin Marchena-Gomez
  • Marion Hemmersbach-Miller
  • Asuncion Acosta-Merida
  • Alvaro Rodriguez-Mendez
  • Roberto Fariña-Castro
  • Juan Hernandez-Romero
Original Article


Background and aims

Hartmann’s operation is widely used for the surgical treatment of complicated left colonic disease. However, many patients never undergo reanastomosis. This study analyzes the factors related to the decision of restoring intestinal continuity.

Materials and methods

Between 1997 and 2004, 162 patients underwent Hartmann’s operation in our institution. Age, sex, anesthetic risk evaluation (ASA score), underlying disorder (neoplastic vs non-neoplastic), prevalence of colonic reconstruction, as well as postoperative length of hospital stay, perioperative mortality and complications due to the latter procedure were analyzed. Long-term survival was also recorded.


Patients’ mean age was 68.7 years (SD ± 14.9); 104 were men (64.2%) and 58 were women (35.8%). Hartmann’s operation mortality was 20.4%. Forty-two colonic continuity restorations were performed (25.9%). Mean time until reconstruction procedure was 13.3 months. There were no deaths (mortality 0%), but 23 cases suffered complications (54.8%). No suture dehiscence was observed. Estimated probability of being alive 1, 3, and 5 years after the initial operation was 64.1, 50.4, and 44.3%, respectively. Significant univariate predictors of reversal were male sex (p = 0.003), non-neoplastic disorder (p = 0.004), younger age (p = 0.001) and lower anesthetic risk (p = 0.009). In the multivariate analysis, independent predictive factors were age (OR: 0.94; 95% CI: 0.91–0.98), non-neoplastic disorder (OR: 0.16; 95% CI: 0.05–0.45), and lower anesthetic risk (OR: 0.22; 95% CI: 0.08–0.58).


Hartmann’s procedure implies a high mortality and a low percentage of restoration of intestinal continuity. In selected patients, closure of Hartmann’s colostomy is a safe procedure, but has a significant morbidity.


Hartmann’s procedure Restoration of intestinal continuity Operative risk 


  1. 1.
    Hartmann H (1923) Note sur un procéde nouveau d’extirpation des cancers de la partie du côlon. Bull Mem Soc Chir Paris 49:1474–1477Google Scholar
  2. 2.
    Desai DC, Brennan EJ Jr, Reilly JF, Smink RD Jr (1998) The utility of the Hartmann procedure. Am J Surg 175(2):152–154PubMedCrossRefGoogle Scholar
  3. 3.
    Schein M, Decker G (1988) The Hartmann procedure. Extended indications in severe intra-abdominal infection. Dis Colon Rectum 31(2):126–129PubMedCrossRefGoogle Scholar
  4. 4.
    Banerjee S, Leather AJ, Rennie JA, Samano N, Gonzalez JG, Papagrigoriadis S (2005) Feasibility and morbidity of reversal of Hartmann’s. Colorectal Dis 7(5):454–459PubMedCrossRefGoogle Scholar
  5. 5.
    Albarran SA, Simoens C, Takeh H, Mendes DC (2004) Restoration of digestive continuity after Hartmann’s procedure. Hepatogastroenterology 51(58):1045–1049PubMedGoogle Scholar
  6. 6.
    Ghorra SG, Rzeczycki TP, Natarajan R, Pricolo VE (1999) Colostomy closure: impact of preoperative risk factors on morbidity. Am Surgeon 65(3):266–269PubMedGoogle Scholar
  7. 7.
    Paredes JP, Cainzos M, Garcia J, Parada P, Fernandez E, Paulos A et al (1994) Colostomy closure: is it an intervention without risk? Rev Esp Enferm Dig 86(4):733–737PubMedGoogle Scholar
  8. 8.
    Pearce NW, Scott SD, Karran SJ (1992) Timing and method of reversal of Hartmann’s procedure. Br J Surg 79(8):839–841PubMedCrossRefGoogle Scholar
  9. 9.
    Griffen FD, Knight CD Sr, Whitaker JM, Knight CD Jr (1990) The double stapling technique for low anterior resection. Results, modifications, and observations. Ann Surg 211(6):745–751PubMedCrossRefGoogle Scholar
  10. 10.
    Gonzalez OA, Duran RO, Avalos GJ, Herrera CG, Orozco MA, Gutierrez de la Rosa JL et al (1999) Hartmann’s procedure. Institutional experience with 92 consecutive cases. Rev Gastroenterol Mex 64(3):127–133Google Scholar
  11. 11.
    Khosraviani K, Campbell WJ, Parks TG, Irwin ST (2000) Hartmann procedure revisited. Eur J Surg 166(11):878–881PubMedCrossRefGoogle Scholar
  12. 12.
    Wigmore SJ, Duthie GS, Young IE, Spalding EM, Rainey JB (1995) Restoration of intestinal continuity following Hartmann’s procedure: the Lothian experience 1987–1992. Br J Surg 82(1):27–30PubMedCrossRefGoogle Scholar
  13. 13.
    Pachler J, Wille-Jorgensen P (2005) Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev (2): CD004323. DOI 10.1002/14651858
  14. 14.
    Vironen JH, Kairaluoma M, Aalto AM, Kellokumpu IH (2006) Impact of functional results on quality of life after rectal cancer surgery. Dis Colon Rectum 49(5):568–578PubMedCrossRefGoogle Scholar
  15. 15.
    Roe AM, Prabhu S, Ali A, Brown C, Brodribb AJ (1991) Reversal of Hartmann’s procedure: timing and operative technique. Br J Surg 78(10):1167–1170PubMedCrossRefGoogle Scholar
  16. 16.
    Bielecki K, Kaminski P (1995) Hartmann procedure: place in surgery and what after? Int J Colorectal Dis 10(1):49–52PubMedCrossRefGoogle Scholar
  17. 17.
    Biondo S, Jaurrieta E, Jorba R, Moreno P, Farran L, Borobia F et al (1997) Intraoperative colonic lavage and primary anastomosis in peritonitis and obstruction. Br J Surg 84(2):222–225PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Cristina Roque-Castellano
    • 1
  • Joaquin Marchena-Gomez
    • 2
  • Marion Hemmersbach-Miller
    • 3
  • Asuncion Acosta-Merida
    • 1
  • Alvaro Rodriguez-Mendez
    • 1
  • Roberto Fariña-Castro
    • 4
  • Juan Hernandez-Romero
    • 1
  1. 1.Department of General SurgeryUniversity Hospital Gran Canaria “Dr. Negrin”Las Palmas G.C.Spain
  2. 2.Department of General SurgeryUniversity Hospital Gran Canaria “Dr. Negrin”Las PalmasSpain
  3. 3.Department of Internal MedicineUniversity Hospital Gran Canaria “Dr. Negrin”Las Palmas G.C.Spain
  4. 4.Department of AnesthesiologyUniversity Hospital Gran Canaria “Dr. Negrin”Las Palmas G.C.Spain

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