Routine Evaluation of the Distal Colon Remnant Before Hartmann’s Reversal is Not Necessary in Asymptomatic Patients

  • Nikiforos Ballian
  • Barbara Zarebczan
  • Alejandro Munoz
  • Bruce Harms
  • Charles P. Heise
  • Eugene F. Foley
  • Gregory D. Kennedy
Original Article

Abstract

Background

Reversal of Hartmann’s is a common surgical procedure. Routine preoperative evaluation of the distal colonic/rectal remnant (DCRR) with contrast and/or endoscopic studies is frequently performed despite lack of evidence to support this practice. We hypothesize that asymptomatic patients can safely undergo Hartmann’s reversal without preoperative DCRR evaluation.

Methods

Adult patients undergoing reversal of Hartmann’s at a single institution were retrospectively identified. Operative characteristics and outcomes in patients with and without preoperative DCRR evaluation were compared.

Results

Between 1993 and 2008, 203 patients underwent reversal of Hartmann’s at a tertiary referral center. Sixty-eight patients (33%) did not undergo preoperative DCRR evaluation and had comparable demographic characteristics, comorbidities, DCRR length, and perioperative outcomes to 135 patients who underwent preoperative contrast and/or endoscopic studies. After evaluation, 125 (93%) patients had normal findings, seven (5%) patients had abnormal studies that did not impact their management, and three (2%) patients underwent additional procedures.

Conclusion

Hartmann’s reversal without previous DCRR evaluation is acceptable in selected asymptomatic patients, without increased risk of complications.

Keywords

Hartmann’s procedure Colostomy Enema Endoscopy 

References

  1. 1.
    Haas PA, Haas GP. A critical evaluation of the Hartmann’s procedure. Am Surg 1988;54:380–385.PubMedGoogle Scholar
  2. 2.
    Belmonte C, Klas JV, Perez JJ, Wong WD, Rothenberger DA, Goldberg SM, et al. The Hartmann procedure. First choice or last resort in diverticular disease? Arch Surg 1996;131:612–615.PubMedGoogle Scholar
  3. 3.
    Schein M, Decker G. The Hartmann procedure. Extended indications in severe intra-abdominal infection. Dis Colon Rectum 1988;31:126–129.CrossRefPubMedGoogle Scholar
  4. 4.
    Sweeney JL, Hoffmann DC. Restoration of continuity after Hartmann’s procedure for the complications of diverticular disease. Aust N Z J Surg 1987;57:823–825.CrossRefPubMedGoogle Scholar
  5. 5.
    Salem L, Anaya DA, Roberts KE, Flum DR. Hartmann’s colectomy and reversal in diverticulitis: a population-level assessment. Dis Colon Rectum 2005;48:988–995.CrossRefPubMedGoogle Scholar
  6. 6.
    Cherukuri R, Levine MS, Maki DD, Rubesin SE, Laufer I, Rosato EF. Hartmann’s pouch: radiographic evaluation of postoperative findings. AJR Am J Roentgenol 1998;171:1577–1582.PubMedGoogle Scholar
  7. 7.
    American Society of Anesthesiologists. ASA physical status classification system. Available at http://www.asahq.org/clinical/physicalstatus.htm.
  8. 8.
    Mazeh H, Samet Y, Abu-Wasel B, Beglaibter N, Grinbaum R, Cohen T, et al. Application of a novel severity grading system for surgical complications after colorectal resection. J Am Coll Surg 2009;208:355–361.CrossRefPubMedGoogle Scholar
  9. 9.
    Aydin HN, Remzi FH, Tekkis PP, Fazio VW. Hartmann’s reversal is associated with high postoperative adverse events. Dis Colon Rectum 2005;48:2117–2126.CrossRefPubMedGoogle Scholar
  10. 10.
    Haas PA, Fox TA Jr. The fate of the forgotten rectal pouch after Hartmann’s procedure without reconstruction. Am J Surg 1990;159:106–110.CrossRefPubMedGoogle Scholar
  11. 11.
    Thaemert BC, Kisken WA. Neoplasms in long-term Hartmann’s pouches. Wis Med J 1996;95:105–107.PubMedGoogle Scholar
  12. 12.
    da Silva GM, Wexner SD, Gurland B, Gervaz P, Moon SD, Efron J, Nogueras JJ, Weiss EG, Vernava AM, Zmora O. Is routine pouchogram prior to ileostomy closure in colonic J-pouch really necessary? Colorectal Dis 2004;6:117–120.CrossRefPubMedGoogle Scholar
  13. 13.
    Orsay CP, Kim DO, Pearl RK, Abcarian H. Diversion colitis in patients scheduled for colostomy closure. Dis Colon Rectum 1993;36:366–367.CrossRefPubMedGoogle Scholar
  14. 14.
    Chua CL. Surgical considerations in the Hartmann’s procedure. Aust N Z J Surg 1996;66:676–679.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Nikiforos Ballian
    • 1
  • Barbara Zarebczan
    • 1
  • Alejandro Munoz
    • 1
  • Bruce Harms
    • 1
  • Charles P. Heise
    • 1
  • Eugene F. Foley
    • 1
  • Gregory D. Kennedy
    • 1
  1. 1.Department of SurgeryUniversity of WisconsinMadisonUSA

Personalised recommendations