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Hartmann’s reversal as a safe procedure for selected patients: analysis of 199 patients at a high-volume center in Sao Paulo

  • Alberto Bitran
  • Roberto RasslanEmail author
  • Fabio de Oliveira Ferreira
  • Edivaldo Massazo Utiyama
  • Samir Rasslan
Original Article
  • 13 Downloads

Abstract

Purpose

We analyzed the morbidity and mortality associated with Hartmann’s reversal (HR) and the risk factors for major complications and mortality.

Methods

The subjects of this retrospective study were patients who underwent HR in a high-volume center. We evaluated complications as categorical variables using univariate analyses.

Results

Between 2003 and 2018, 199 patients underwent HR at our hospital [56.5 years; body mass index (BMI): 26.3 kg/m2; American Society of Anesthesiology score (ASA) 3: 7.5%; 36.2% had hernias]. The mean time to HR was 20.2 months and the mean operation time was 302 min. The anastomosis was stapled in 71.4% and was performed in the low/medium rectum in 21.6%. Midline hernias were repaired with mesh in 80.1%. The mean hospitalization period was 10.1 days. Surgical site infection (SSI) developed in 27.1% of the patients, 94.4% of whom were treated at the bedside. BMI was a risk factor for SSI (27.8 vs. 25.6; p = 0.047). Major complications (Clavien–Dindo III–V) developed in 27 patients (13.5%), including anastomosis dehiscence in 2.5%. ASA, BMI, age, hernia repair, and rectal stump size were not associated with major complications. The mortality rate was 2.5%. An ASA of 3 was associated with high mortality (p = 0.03).

Conclusion

Hartmann’s reversal remains challenging but can have low complication and mortality rates if performed on selected patients in a reference center. An ASA of 3 was the only predictor of mortality.

Keywords

Stoma Hartmann’s reversal Ostomy closure Postoperative outcome Morbidity 

Notes

Author contributions

All authors involved in this study agree with the submission. AB and RR were involved in the conception and design of the study, acquisition of data, analysis and interpretation of data. FOF was involved in the data analysis. EMU and SR were involved in drafting the article and revising it critically for important intellectual content.

Funding

This work was not supported.

Compliance with ethical standards

Conflict of interest

None to declare.

Ethical approval

This study was approved by the Hospital das Clinicas ethics committee. Protocol number: 0736/10.

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Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Department of SurgeryFaculdade de Medicina da Universidade de São PauloSão PauloBrazil

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