INTRODUCTION: First described in 1921, Hartmann's procedure is the gold standard treatment for complicated sigmoid diverticular disease. It is also used commonly for other causes of perforation of the large bowel. However, the reversal rate in the UK is much lower than in comparable countries, at only 18-22%. Furthermore, laparoscopic reversal (LRH) is used far less frequently than open reversal (ORH) despite evidence that a laparoscopic technique reduces patient morbidity and decreases patient recovery time. METHODS: This retrospective case note review undertook an analysis of all the patients who had undergone Hartmann's procedure at two centres in Leeds Teaching Hospitals NHS Trust between February 2007 and February 2012. Out of 305 patients, 235 were identified and included in the analysis. Comparisons were then drawn between LRH and ORH groups. RESULTS: The reversal rate was 21%. Three-quarters (76%) were performed using an open technique, 20% were laparoscopic and 5% were converted to an open procedure. The mean hospital stay was longer for the ORH group (9.82 days, standard deviation [SD]: 5.85 days, 95% confidence interval [CI]: 2.99 days) than for the LRH group (7.29 days, SD: 4.65 days, 95% CI: 11.58 days) p=0.006). Seven ORH patients (21%) were reoperated but only one LRH patient (13%) had a reoperation at six months. Five factors were found to have a significant effect on the likelihood of reversal of Hartmann's procedure. CONCLUSIONS: The overall reversal rate for Hartmann's procedure remains low. Shorter hospital stays, lower 6-month reoperation rates and reduced 30-day complication rates are associated with LRH when compared with ORH.
INTRODUCTION: First described in 1921, Hartmann's procedure is the gold standard treatment for complicated sigmoid diverticular disease. It is also used commonly for other causes of perforation of the large bowel. However, the reversal rate in the UK is much lower than in comparable countries, at only 18-22%. Furthermore, laparoscopic reversal (LRH) is used far less frequently than open reversal (ORH) despite evidence that a laparoscopic technique reduces patient morbidity and decreases patient recovery time. METHODS: This retrospective case note review undertook an analysis of all the patients who had undergone Hartmann's procedure at two centres in Leeds Teaching Hospitals NHS Trust between February 2007 and February 2012. Out of 305 patients, 235 were identified and included in the analysis. Comparisons were then drawn between LRH and ORH groups. RESULTS: The reversal rate was 21%. Three-quarters (76%) were performed using an open technique, 20% were laparoscopic and 5% were converted to an open procedure. The mean hospital stay was longer for the ORH group (9.82 days, standard deviation [SD]: 5.85 days, 95% confidence interval [CI]: 2.99 days) than for the LRH group (7.29 days, SD: 4.65 days, 95% CI: 11.58 days) p=0.006). Seven ORHpatients (21%) were reoperated but only one LRH patient (13%) had a reoperation at six months. Five factors were found to have a significant effect on the likelihood of reversal of Hartmann's procedure. CONCLUSIONS: The overall reversal rate for Hartmann's procedure remains low. Shorter hospital stays, lower 6-month reoperation rates and reduced 30-day complication rates are associated with LRH when compared with ORH.
Authors: Marco Braga; Andrea Vignali; Luca Gianotti; Walter Zuliani; Giovanni Radaelli; Paola Gruarin; Paolo Dellabona; Valerio Di Carlo Journal: Ann Surg Date: 2002-12 Impact factor: 12.969
Authors: J V Roig; M Cantos; Z Balciscueta; N Uribe; J Espinosa; V Roselló; R García-Calvo; J Hernandis; F Landete Journal: Colorectal Dis Date: 2011-12 Impact factor: 3.788
Authors: Jennifer Chapman; Michael Davies; Bruce Wolff; Eric Dozois; Deron Tessier; Jeffrey Harrington; Dirk Larson Journal: Ann Surg Date: 2005-10 Impact factor: 12.969
Authors: A M Lacy; J C García-Valdecasas; J M Piqué; S Delgado; E Campo; J M Bordas; P Taurá; L Grande; J Fuster; J L Pacheco Journal: Surg Endosc Date: 1995-10 Impact factor: 4.584
Authors: Robert S Krouse; Lisa J Herrinton; Marcia Grant; Christopher S Wendel; Sylvan B Green; M Jane Mohler; Carol M Baldwin; Carmit K McMullen; Susan M Rawl; Eric Matayoshi; Stephen Joel Coons; Mark C Hornbrook Journal: J Clin Oncol Date: 2009-08-31 Impact factor: 44.544
Authors: Francesco Guerra; Diego Coletta; Celeste Del Basso; Giuseppe Giuliani; Alberto Patriti Journal: World J Surg Date: 2019-07 Impact factor: 3.352
Authors: Stewart Whitney; Benjamin D Gross; Alex Mui; Sue Hahn; Blake Read; Joel Bauer Journal: Int J Colorectal Dis Date: 2020-06-05 Impact factor: 2.571
Authors: Pooja Saini; Antony Martin; Jason McIntyre; Anna Balmer; Sam Burton; Hana Roks; Laura Sambrook; Amrith Shetty; Rajan Nathan Journal: PLoS One Date: 2022-03-08 Impact factor: 3.240