Skip to main content

Advertisement

SpringerLink
Log in

Hartmann’s reversal after colonic perforation or anastomosis leakage, is it the same procedure? A retrospective study of 150 patients

  • ORIGINAL ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

The high morbidity rates reported might influence surgeons’ decisions of whether to perform Hartmann’s reversal (HR). Our aim was to report the results of HR after “primary” Hartmann’s procedure (HP) or in redo surgery for failed anastomosis.

Methods

All patients operated between 2007 and 2015 were included. Data and postoperative course were obtained from a review of medical records and databases.

Results

One hundred fifty patients (age 60, range (20–91) years, 62% male) were included. Eighty-six patients (57%) were ASA ≥ 2. HP was mostly performed for diverticulitis (29.3%) and anastomotic leakage (24%). HR was possible in 145(97%) patients including six with previous failed attempt. Overall morbidity was 22.7% including 11.7% severe complications (Dindo 3–4). Operative blood loss and Charlson comorbidity index were the only significant risk factor for postoperative pelvic complications (p = 0.03; p = 0.0002, respectively).

Conclusions

In a colorectal tertiary center, HR was feasible in 97% with a low morbidity and a 3.4% anastomotic leakage rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Roque-Castellano C, Marchena-Gomez J, Hemmersbach-Miller M, Acosta-Merida A, Rodriguez-Mendez A, Farina-Castro R et al (2007) Analysis of the factors related to the decision of restoring intestinal continuity after Hartmann’s procedure. Int J Color Dis 22:1091–1096

    Article  Google Scholar 

  2. Fleming FJ, Gillen P (2009) Reversal of Hartmann’s procedure following acute diverticulitis: is timing everything? Int J Color Dis 24:1219–1225

    Article  Google Scholar 

  3. van de Wall BJ, Draaisma WA, Schouten ES, Broeders IA, Consten EC (2010) Conventional and laparoscopic reversal of the Hartmann procedure: a review of literature. J Gastrointest Surg 14:743–752

    Article  PubMed  Google Scholar 

  4. Vermeulen J, Coene PP, Van Hout NM, van der Harst E, Gosselink MP, Mannaerts GH et al (2009) Restoration of bowel continuity after surgery for acute perforated diverticulitis: should Hartmann’s procedure be considered a one-stage procedure? Color Dis 11:619–624

    Article  CAS  Google Scholar 

  5. den Dulk M, Smit M, Peeters KC, Kranenbarg EM, Rutten HJ, Wiggers T, Putter H, van de Velde C, Dutch Colorectal Cancer Group (2007) A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol 8:297–303

    Article  Google Scholar 

  6. Maggiori L, Bretagnol F, Lefevre JH, Ferron M, Vicaut E, Panis Y (2011) Conservative management is associated with a decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer. Color Dis 13:632–637

    Article  CAS  Google Scholar 

  7. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  8. Pitel S, Lefevre JH, Tiret E, Chafai N, Parc Y (2012) Redo coloanal anastomosis: a retrospective study of 66 patients. Ann Surg 256:806–810 discussion 10-1

    Article  PubMed  Google Scholar 

  9. Bennis M, Parc Y, Lefevre JH, Chafai N, Attal E, Tiret E (2012) Morbidity risk factors after low anterior resection with total mesorectal excision and coloanal anastomosis: a retrospective series of 483 patients. Ann Surg 255:504–510

    Article  PubMed  Google Scholar 

  10. Parc Y, Frileux P, Schmitt G, Dehni N, Ollivier JM, Parc R (2000) Management of postoperative peritonitis after anterior resection: experience from a referral intensive care unit. Dis Colon Rectum 43:579–587 discussion 87-9

    Article  PubMed  CAS  Google Scholar 

  11. Lefevre JH, Bretagnol F, Maggiori L, Ferron M, Alves A, Panis Y (2011) Redo surgery for failed colorectal or coloanal anastomosis: a valuable surgical challenge. Surgery 149:65–71

    Article  PubMed  Google Scholar 

  12. Antolovic D, Reissfelder C, Ozkan T, Galindo L, Buchler MW, Koch M et al (2011) Restoration of intestinal continuity after Hartmann’s procedure—not a benign operation. Are there predictors for morbidity? Langenbeck’s Arch Surg 396:989–996

    Article  Google Scholar 

  13. Banbury MK, Brizzio ME, Rajeswaran J, Lytle BW, Blackstone EH (2006) Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg 202:131–138

    Article  PubMed  Google Scholar 

  14. Bannay A, Chaignot C, Blotiere PO, Basson M, Weill A, Ricordeau P et al (2016) The best use of the Charlson comorbidity index with electronic health care database to predict mortality. Med Care 54:188–194

    Article  PubMed  Google Scholar 

  15. Toro A, Ardiri A, Mannino M, Politi A, Di Stefano A, Aftab Z et al (2014) Laparoscopic reversal of Hartmann’s procedure: state of the art 20 years after the first reported case. Gastroenterol Res Pract 2014:530140

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rosen MJ, Cobb WS, Kercher KW, Sing RF, Heniford BT (2005) Laparoscopic restoration of intestinal continuity after Hartmann’s procedure. Am J Surg 189:670–674

    Article  PubMed  Google Scholar 

  17. da Silva RG, de Castro Junior GR, Ferreira CL, da Luz MM, da Conceicao SA, Lacerda-Filho A (2010) Restoration of intestinal continuity after Hartmann’s procedure. Rev Col Bras Cir 37:17–22

    Article  PubMed  Google Scholar 

  18. Maitra RK, Pinkney TD, Mohiuddin MK, Maxwell-Armstrong CA, Williams JP, Acheson AG (2013) Should laparoscopic reversal of Hartmann’s procedure be the first line approach in all patients? Int J Surg 11:971–976

    Article  PubMed  CAS  Google Scholar 

  19. Celentano V, Giglio MC, Bucci L (2015) Laparoscopic versus open Hartmann’s reversal: a systematic review and meta-analysis. Int J Color Dis 30:1603–1615

    Article  Google Scholar 

  20. Zimmermann M, Hoffmann M, Laubert T, Meyer KF, Jungbluth T, Roblick UJ et al (2014) Laparoscopic versus open reversal of a Hartmann procedure: a single-center study. World J Surg 38:2145–2152

    Article  PubMed  Google Scholar 

  21. Chereau N, Lefevre JH, Lefrancois M, Chafai N, Parc Y, Tiret E (2013) Management of malignant left colonic obstruction: is an initial temporary colostomy followed by surgical resection a better option? Color Dis 15:e646–e653

    Article  CAS  Google Scholar 

  22. Constantinides VA, Tekkis PP, Senapati A, Association of Coloproctology of Great Britain I (2006) Prospective multicentre evaluation of adverse outcomes following treatment for complicated diverticular disease. Br J Surg 93:1503–1513

    Article  PubMed  CAS  Google Scholar 

  23. Toro A, Mannino M, Reale G, Cappello G, Di Carlo I (2012) Primary anastomosis vs Hartmann procedure in acute complicated diverticulitis. Evolution over the last twenty years. Chirurgia (Bucur) 107:598–604

    CAS  Google Scholar 

  24. Masoomi H, Stamos MJ, Carmichael JC, Nguyen B, Buchberg B, Mills S (2012) Does primary anastomosis with diversion have any advantages over Hartmann’s procedure in acute diverticulitis? Dig Surg 29:315–320

    Article  PubMed  Google Scholar 

  25. Vennix S, Musters GD, Mulder IM, Swank HA, Consten EC, Belgers EH, van Geloven AA, Gerhards MF, Govaert MJ, van Grevenstein WM, Hoofwijk AG, Kruyt PM, Nienhuijs SW, Boermeester MA, Vermeulen J, van Dieren S, Lange JF, Bemelman WA (2015) Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial. Lancet 386:1269–1277

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive and General Surgery, Hôpital Saint Antoine, Sorbonne Université, Paris VI, France

    Nathalie Chereau, Jeremie H. Lefevre, Najim Chafai, Thevy Hor, Clotilde Debove, Emmanuel Tiret & Yann Parc

Authors
  1. Nathalie Chereau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeremie H. Lefevre
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Najim Chafai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thevy Hor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Clotilde Debove
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emmanuel Tiret
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yann Parc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeremie H. Lefevre.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chereau, N., Lefevre, J.H., Chafai, N. et al. Hartmann’s reversal after colonic perforation or anastomosis leakage, is it the same procedure? A retrospective study of 150 patients. Langenbecks Arch Surg 403, 435–441 (2018). https://doi.org/10.1007/s00423-018-1667-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-018-1667-0

Keywords

Search

Navigation