Title : Hartmann’s procedure: Hard to revise?
Abstract:
AIM: The Hartmann's procedure is commonly regarded as a two-stage procedure. This study aims to evaluate the outcome of the Hartmann's procedure with respect to the rate of reversal and associated morbidity.
METHODS: This retrospective study analyzed all patients who underwent either the Hartmann's procedure or Hartmann's reversal at Amrita Institute of Medical Sciences, Kochi, between 2008 and 2014.
RESULTS: A total of 110 patients underwent the Hartmann's procedure during the study period. Rectal and sigmoid malignancies were the most common indications (64.9%), followed by perforated sigmoid diverticulitis (13%). The mean age of patients was 65 years (range 28-94), and 62.5% were males. Elective Hartmann's procedure was performed in 60.5% of patients. In the immediate postoperative period, 11.8% of patients died. All surviving patients were followed up for a median of 550 days. Of the remaining 97 patients, 52.5% underwent reversal after a median period of 5 months. The postoperative morbidity rate was 40%, including anastomotic site stricture, leaks, surgical site infection, and the need for diverting ileostomy. There was no mortality in this group. Among the 46 patients who did not undergo reversal, all had Hartmann's due to malignancy. In 55.2% of these patients, Hartmann's was not reversed due to either patient frailty or unwillingness to undergo surgery. Non-reversal of Hartmann's was more common in patients with stage 3 tumors (92%) and age above 69 years (70%). There was no significant difference in comorbidity between the two groups.
CONCLUSION: The Hartmann's procedure has approximately a 50% chance of reversal and is associated with significant morbidity. Hartmann's procedure performed for benign pathology and in younger patients is more likely to be reversed compared to malignancy and older patients.
Audience Take Away:
• The audience will learn about the outcome of Hartmann's procedure in terms of its reversal rate and associated morbidity
• This will help the audience to discuss the real chance of stoma reversal when consenting patients for Hartmann’s procedure.
• The audience will learn that Hartmann's procedure is associated with a 50% chance of reversal and significant morbidity. The decision to undergo the procedure should be made after considering the patient's age, co-morbidities, and the underlying pathology.
