Hartmann Procedure: Is It Still Relevant Today?

Seah, Dee Wern; Şehitoğlu, İbrahim; Tay, Kiang-Hiong

doi:10.1111/j.1445-2197.2005.03367.x

Cited by 56 publications

(54 citation statements)

References 29 publications

(28 reference statements)

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“…In our material, intestinal continuity after the Hartmann procedure was restored only in 10.2% of patients. A similarly low rate of restoration (0-35%) has been reported by other authors (6,7,12). It probably results from the fact that postoperative and postradiation changes in the pelvis minor preclude safe dissection of the rectal stump and its preparation for anastomosis.…”

Section: Discussionmentioning

confidence: 63%

“…Local resection of rectal cancer, especially with the use of the TEM technique (transanal endoscopic microsurgery) gives good functional results and entails low risk of complications, but indications for local resection are limited to a strictly selected, and thus sparse, group of patients with early stage tumour (1)(2)(3)(4)(5). The rate of reconstructive surgeries after the Hartmann procedure in patients with rectal cancer is low (6,7). The best chance for maintaining intestinal continuity can be seen in the anterior resection, which, however, entails the risk of leak from a lowlying anastomosis, which can necessitate reoperation and formation of a permanent colostomy.…”

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confidence: 99%

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Risk of Permanent Stoma After Resection of Rectal Cancer Depending on the Distance Between the Tumour Lower Edge and Anal Verge

Rutkowski¹,

Chwaliński²,

Zajâc³

et al. 2011

Polish Journal of Surgery

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The distance between the anal verge and lower edge of rectal cancer is one of the most important factors affecting the feasibility of sphincter-preserving resection. the aim of the study was to assess the risk of permanent stoma after resection of rectal tumour depending on the distance between the tumour and the anal verge. material and methods. The retrospective analysis covered 884 patients after resection of rectal cancer. The distance between the anal verge and the lowest edge of the tumour was measured during endoscopic examination. Surgical technique was similar in all cases. For statistical analysis, the chisquare test and Fisher exact test were used. Results. The overall rate of sphincter-preserving procedures was 71.8%, 90.1% of which were anterior resections. The greatest differences between the rate of anterior resections were noted for the segment between the 4 th and the 5 th centimetres: 30.1% for 4 cm vs 66.7% for 5 cm, p = 0.005. Overall, in 328 patients (37.1%) surgical treatment resulted in a permanent stoma. The number included: 246 (75.0%) patients after abdominosacral resection, 44 (13.4%) patients after the Hartmann procedure, three (0.9%) patients after proctocolectomy, and 28 (8.5%) patients after anterior resection, with a permanent stoma as a result of anastomotic leak. The overall rate of anastomotic leak was 11.7%. Formation of a defunctioning stoma in patients with a low-lying (≤ 6 cm from the anal verge) tumour reduced the risk of symptomatic anastomotic leak: 6.3% vs 20.5%; p = 0.049. Conclusions. Anterior resection of tumours located ≥ 6 cm from the anal verge is feasible in 90%. Anastomotic leak that requires reoperation increases the risk of permanent colostomy. In selected cases, formation of a defunctioning stoma after resection of low-lying rectal cancer can reduce the risk of permanent colostomy. Key words: rectal cancer, tumor position, sphincter saving surgery Maintenance of intestinal continuity is one of the most important issues for the patient with rectal cancer. Concerns about having a permanent intestinal fistula formed sometimes affects the decision whether or not to consent to surgical treatment. When planning treatment, a number of clinical aspects are taken into consideration, such as the patient's general condition, patency of gastrointestinal tract and tumour staging. One of the most important factors affecting the feasibility of a sphincterpreserving surgery is the location of rectal cancer with respect to the anal verge. If sphincters are infiltrated by the cancer, the only method of radical surgical treatment left is abdominoperineal or abdominosacral resection. Local resection of rectal cancer, especially with the use of the TEM technique (transanal endoscopic microsurgery) gives good functional results and entails low risk Unauthenticated Download Date | 5/12/18 10:09 AM

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Section: Discussionmentioning

confidence: 63%

mentioning

confidence: 99%

Risk of Permanent Stoma After Resection of Rectal Cancer Depending on the Distance Between the Tumour Lower Edge and Anal Verge

Rutkowski¹,

Chwaliński²,

Zajâc³

et al. 2011

Polish Journal of Surgery

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“…Nevertheless, many others have concluded that immunosuppression, septic shock, fecal peritonitis, or high cardiac risk patients at admission were correlated with higher morbidity and mortality rates, and that usage of a two-stage procedure with or without primary anastomosis would be safer than one-stage surgery. [1,5,16,18] There is no comment about the timing of the second stage of the operation, but most of the authors favor delaying the second stage, usually preferring to perform it 6 months after the first stage. [14,18] In conclusion, colon perforation due to immunoUnexpected colonic perforation in a renal recipient Ulus Travma Acil Cerrahi Derg suppressant use in renal allograft recipients is a rare but serious complication, with high mortality and morbidity rates.…”

Section: Discussionmentioning

confidence: 99%

“…[1,5,16,18] There is no comment about the timing of the second stage of the operation, but most of the authors favor delaying the second stage, usually preferring to perform it 6 months after the first stage. [14,18] In conclusion, colon perforation due to immunoUnexpected colonic perforation in a renal recipient Ulus Travma Acil Cerrahi Derg suppressant use in renal allograft recipients is a rare but serious complication, with high mortality and morbidity rates. It must be diagnosed early and treated aggressively.…”

Section: Discussionmentioning

confidence: 99%

Unexpected Colonic Perforation in a Renal Recipient. A Case Report

Serin¹,

Keskin²,

Bakkaloglu³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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İmmünite baskılayıcı ilaçlara bağlı olarak gelişen gastrointestinal kanama ve perforasyon gibi komplikasyonlar sıklıkla solid organ nakli sonrası görülmektedir. Elli iki yaşında erkek hasta canlı vericiden böbrek naklinin 7. günün-de yara yerinden akıntı şikayeti ile başvurdu. Herhangi bir karın ağrısı yoktu. Üçlü immünsupresan kullanmakta idi. Karın grafisi ve ultrasonografisi normal saptandı ancak bilgisayarlı tomografide karın içerisinde yaygın serbest hava görüldü. Transplante böbrek fonksiyonları da dahil olmak üzere laboratuvar incelemesinde herhangi bir patolojik bulgu saptanmadı. Tanısal laparoskopi sonrası açığa dönüldü. Antimezenterik yüzde sigmoid kolon perforasyonu vardı. Divertikülit ve iskemi bulgusu yoktu, travmaya ait bulgu da görülmedi. Transrektal enstrümentasyon anamnezi de yoktu. Omentoplasti ve sigmoid loop kolostomi yapıl-dı. Ameliyatının dokuzuncu günüde hasta taburcu edildi. Ameliyatının birinci yılında da kolostomisi kapatıldı. Gastrointestinal komplikasyonlar ölümcül olabilir ancak uzun dönem sağkalımı ve gref fonksiyonunu etkilemedikleri bilinmektedir. Pekçoğu ameliyat sonrası erken dönem veya rejeksiyon atakları gibi yüksek doz immünite baskılayıcı ilaç kullanılan dönemde görülmektedir. Sağkalımda erken tanı ve tedavide agresif davranmak önemli rol oynar.Anahtar Sözcükler: Kolon perforasyonu; kolostomi; immünsup-resyon.Gastrointestinal complications such as gastrointestinal bleeding and perforation due to immunosuppressant use are seen more frequently after solid organ transplantation. A 52-year-old male was admitted on the 7th day of a living donor renal transplantation with serous drainage at the incision site. He had no abdominal complaints. He was on triple immunosuppressant therapy. Abdominal plain X-ray and ultrasonography were normal, but diffuse extraluminal air was detected on the computed tomography scan. There were no pathological laboratory findings regarding the function of the renal allograft. We began the operation laparoscopically and then converted to laparotomy. Sigmoid colonic perforation was detected on the antimesenteric side. Neither diverticulitis nor ischemia was observed, and no evidence of iatrogenic injury was seen. There was no transrectal instrumentation history. Omentoplasty and sigmoid loop colostomy were performed. He was discharged on the 9th day following the operation. His colostomy was closed one year after the operation. Gastrointestinal complications can be fatal, but do not seem to influence the long-term survival or renal allograft function. Most of them are seen after using high doses of immunosuppressants to manage the early postoperative period or episodes of acute rejection. Early diagnosis and aggressive treatment play an important role in survival.

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“…Dieses Konzept wird derzeit aufgrund zahlreicher Gründe hinterfragt. Die skizzierte Hartmann-Prozedur hat eine hohe perioperative Morbidität um 40% und eine Mortalität von bis zu 20% [33,34]; des Weiteren besteht eine sehr geringe Rate an Kontinuitätswiederherstellung von unter 40%. Liang et al [35] haben in einer erst kürzlich publizierten Arbeit von ihren Erfahrungen mit zwei laparoskopischen Behandlungsstrategien - laparoskopische Lavage und Drainage sowie laparoskopische Hartmann-Operation - für die perforierte Sigmadivertikulitis berichtet.…”

Section: Spezielles Vorgehen Bei Bestimmten Krankheitsbildernunclassified

Grenzen des laparoskopischen Operierens bei abdomineller Sepsis

Keck¹,

Wellner²,

Tittelbach-Helmrich³

et al. 2013

Visc Med

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Hintergrund: Zahlreiche präklinische Daten weisen auf Vorteile des laparoskopischen Operierens auch bei abdomineller Sepsisquelle und septischem Patienten hin. Methode und Ergebnisse: Anhand derzeit verfügbarer Literatur betrachten wir die Möglichkeiten und Limitierungen laparoskopischen Operierens beim septischen Patienten mit abdominellem Fokus. Neben generellen Überlegungen werden im Speziellen das Vorgehen bei Appendizitis, Cholezystitis, perforiertem Ulkus, Sigmadivertikulitis und akuter Pankreatitis erörtert. Schlussfolgerungen: Erfahrene laparoskopische Chirurgen können die Sanierung der abdominellen Sepsisquelle bei Appendizitis, Cholezystitis, perforiertem Ulkus oder auch Sigmadivertikulitis sicher durchführen. Kombinationen aus interventionellen Techniken und minimal invasiven Operationen bieten insbesondere bei der perforierten Sigmadivertikulitis und bei infizierten Pankreasnekrosen innovative Ansätze, die derzeit in multizentrischen prospektiven Studien untersucht werden.

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Hartmann Procedure: Is It Still Relevant Today?

Abstract: Though the idea of primary anastomosis with on table lavage for left sided anastomosis seems attractive, we think the Hartmann procedure is still useful for selected patients.

Cited by 56 publications

References 29 publications

Risk of Permanent Stoma After Resection of Rectal Cancer Depending on the Distance Between the Tumour Lower Edge and Anal Verge

Risk of Permanent Stoma After Resection of Rectal Cancer Depending on the Distance Between the Tumour Lower Edge and Anal Verge

Unexpected Colonic Perforation in a Renal Recipient. A Case Report

Grenzen des laparoskopischen Operierens bei abdomineller Sepsis

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