OBJECTIVE: Reversal of Hartmann's is a major surgical procedure and associated with substantial morbidity and mortality. METHOD: This study retrospectively analysed the data at a single centre over an eight-year period to assess the clinical results and morbidity of reversal of Hartmann's. RESULTS: One hundred and ten Hartmann's procedures were performed during the period. Only 66 (61%) of patients had a reversal. Advanced age and comorbidity were the primary reasons for not reversing. Complications among the 66 patients (36 males and 30 females) who underwent reversal occurred in 26 (41%). There were no deaths. Patients who underwent reversal were ASA 2 (60%), ASA 3 (25%) and ASA 4 (4.6%). Univariate analysis demonstrated a significant association between complications following reversal and ASA grade (P =0.01), and hypertension (P = 0.03) There was no correlation between the patient variables and anastomotic leakage. Multiple logistic regression analysis showed a significant influence of hypertension, smoking and ASA grade on complications. CONCLUSIONS: About 40% of patients who undergo Hartmann's procedure will not have a reversal. Reversal is a feasible operation for selected patients, but there is a high complication rate.
OBJECTIVE: Reversal of Hartmann's is a major surgical procedure and associated with substantial morbidity and mortality. METHOD: This study retrospectively analysed the data at a single centre over an eight-year period to assess the clinical results and morbidity of reversal of Hartmann's. RESULTS: One hundred and ten Hartmann's procedures were performed during the period. Only 66 (61%) of patients had a reversal. Advanced age and comorbidity were the primary reasons for not reversing. Complications among the 66 patients (36 males and 30 females) who underwent reversal occurred in 26 (41%). There were no deaths. Patients who underwent reversal were ASA 2 (60%), ASA 3 (25%) and ASA 4 (4.6%). Univariate analysis demonstrated a significant association between complications following reversal and ASA grade (P =0.01), and hypertension (P = 0.03) There was no correlation between the patient variables and anastomotic leakage. Multiple logistic regression analysis showed a significant influence of hypertension, smoking and ASA grade on complications. CONCLUSIONS: About 40% of patients who undergo Hartmann's procedure will not have a reversal. Reversal is a feasible operation for selected patients, but there is a high complication rate.
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Authors: Hilko A Swank; Jefrey Vermeulen; Johan F Lange; Irene M Mulder; Joost A B van der Hoeven; Laurents P S Stassen; Rogier M P H Crolla; Meindert N Sosef; Simon W Nienhuijs; Robbert J I Bosker; Maarten J Boom; Philip M Kruyt; Dingeman J Swank; Willem H Steup; Eelco J R de Graaf; Wibo F Weidema; Robert E G J M Pierik; Hubert A Prins; Hein B A C Stockmann; Rob A E M Tollenaar; Bart A van Wagensveld; Peter-Paul L O Coene; Gerrit D Slooter; Esther C J Consten; Eino B van Duijn; Michael F Gerhards; Anton G M Hoofwijk; Thomas M Karsten; Peter A Neijenhuis; Charlotte F J M Blanken-Peeters; Huib A Cense; Guido H H Mannaerts; Sjoerd C Bruin; Quirijn A J Eijsbouts; Marinus J Wiezer; Eric J Hazebroek; Anna A W van Geloven; John K Maring; André J L D'Hoore; Alex Kartheuser; Christophe Remue; Helma M U van Grevenstein; Joop L M Konsten; Donald L van der Peet; Marc J P M Govaert; Alexander F Engel; Johannes B Reitsma; Willem A Bemelman Journal: BMC Surg Date: 2010-10-18 Impact factor: 2.102