Nir Horesh1,2,3, Yonatan Lessing4,5, Yaron Rudnicki4,6, Ilan Kent4,6, Haguy Kammar7,8, Almog Ben-Yaacov4,9, Yael Dreznik10,4, Hagit Tulchinsky4,5, Shmuel Avital4,6, Eli Mavor4,7, Nir Wasserberg4,9, Hanoch Kashtan4,9, Joseph M Klausner4,5, Mordechai Gutman10,4, Oded Zmora10,4. 1. Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel. nir_horesh@hotmail.com. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. nir_horesh@hotmail.com. 3. Department of Surgery and Transplantations B, Sheba Medical Center, 52621, Tel-Hashomer, Israel. nir_horesh@hotmail.com. 4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 5. Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel. 6. Department of Surgery B, Meir Medical Center, Kfar Saba, Israel. 7. Department of Surgery, Kaplan Medical Center, Rehovot, Israel. 8. School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel. 9. Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel. 10. Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel.
Abstract
PURPOSE: Hartmann's procedure is commonly practiced in emergent cases with the restoration of bowel continuity planned at a second stage. This study assessed the rate of restorations following Hartmann's procedure and evaluated factors affecting decision-making. METHODS: Data on patient demographics, comorbidities, causes for Hartmann's procedure, reversal rate, and complications were collected in a multicenter retrospective cohort study of patients who underwent Hartmann's procedure in five medical centers. RESULTS: Six hundred forty patients underwent Hartmann's procedure for diverticular disease (36.1%), obstructing malignancy (31.8%), benign obstruction (5%), and other reasons (23.1%). Overall, 260 (40.6%) patients underwent subsequent restoration of bowel continuity. One hundred twenty-one (46.5%) patients had post-reversal complications, with an average Clavien-Dindo score of 1.4 and a mortality rate of 0.77%. Decision to avoid reversal was mostly related to comorbidities (49.7%) and metastatic disease (21.6%). Factors associated with the decision to restore bowel continuity included male gender (P = 0.02), patient age (62.3 years in Hartmann's reversal patients vs 73.5 years in non-reversal patients; P < 0.0001), number of comorbidities (1.1 vs 1.58; P < 0.001), average Charlson score (1.93 vs 3.44; P < 0.001), and a neoplastic etiology (P < 0.0001). A sub-analysis excluding all patients who died in the 30 days following Hartmann's procedure showed similar factors associated with ostomy closure. CONCLUSION: Many patients do not have restoration of bowel continuity after undergoing Hartmann's procedure. Hartmann's reversal is associated with a significant postoperative morbidity. Surgeons and patients should be aware of the possibility that the colostomy might become permanent.
PURPOSE: Hartmann's procedure is commonly practiced in emergent cases with the restoration of bowel continuity planned at a second stage. This study assessed the rate of restorations following Hartmann's procedure and evaluated factors affecting decision-making. METHODS: Data on patient demographics, comorbidities, causes for Hartmann's procedure, reversal rate, and complications were collected in a multicenter retrospective cohort study of patients who underwent Hartmann's procedure in five medical centers. RESULTS: Six hundred forty patients underwent Hartmann's procedure for diverticular disease (36.1%), obstructing malignancy (31.8%), benign obstruction (5%), and other reasons (23.1%). Overall, 260 (40.6%) patients underwent subsequent restoration of bowel continuity. One hundred twenty-one (46.5%) patients had post-reversal complications, with an average Clavien-Dindo score of 1.4 and a mortality rate of 0.77%. Decision to avoid reversal was mostly related to comorbidities (49.7%) and metastatic disease (21.6%). Factors associated with the decision to restore bowel continuity included male gender (P = 0.02), patient age (62.3 years in Hartmann's reversal patients vs 73.5 years in non-reversal patients; P < 0.0001), number of comorbidities (1.1 vs 1.58; P < 0.001), average Charlson score (1.93 vs 3.44; P < 0.001), and a neoplastic etiology (P < 0.0001). A sub-analysis excluding all patients who died in the 30 days following Hartmann's procedure showed similar factors associated with ostomy closure. CONCLUSION: Many patients do not have restoration of bowel continuity after undergoing Hartmann's procedure. Hartmann's reversal is associated with a significant postoperative morbidity. Surgeons and patients should be aware of the possibility that the colostomy might become permanent.
Authors: Luca Ansaloni; Roland E Andersson; Franco Bazzoli; Fausto Catena; Vincenzo Cennamo; Salomone Di Saverio; Lorenzo Fuccio; Hans Jeekel; Ari Leppäniemi; Ernest Moore; Antonio D Pinna; Michele Pisano; Alessandro Repici; Paul H Sugarbaker; Jean-Jaques Tuech Journal: World J Emerg Surg Date: 2010-12-28 Impact factor: 5.469
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: Carmit K McMullen; Mark C Hornbrook; Marcia Grant; Carol M Baldwin; Christopher S Wendel; M Jane Mohler; Andrea Altschuler; Michelle Ramirez; Robert S Krouse Journal: J Support Oncol Date: 2008-04
Authors: Francesco Guerra; Diego Coletta; Celeste Del Basso; Giuseppe Giuliani; Alberto Patriti Journal: World J Surg Date: 2019-07 Impact factor: 3.352
Authors: Ömer Yalkın; Fatih Altıntoprak; Mustafa Yener Uzunoğlu; Yasin Alper Yıldız; Muhammet Burak Kamburoğlu; Necattin Fırat; Fehmi Çelebi Journal: Biomed Res Int Date: 2022-07-04 Impact factor: 3.246
Authors: Jae Hyun Kang; Byung Mo Kang; Sang Nam Yoon; Jeong Yeon Kim; Jun Ho Park; Bo Young Oh; Jong Wan Kim Journal: Sci Rep Date: 2020-10-08 Impact factor: 4.379
Authors: Y Rudnicki; N Horesh; Y Lessing; V Tverskov; A Wachtel; M Slavin; H Tulchinsky; N Wasserberg; E Mavor; O Zmora; S Avital Journal: Sci Rep Date: 2021-01-14 Impact factor: 4.379