Restoration of Digestive Continuity after Hartmann’s Procedure: ASA Score is a Predictive Factor for Risk of Postoperative Complications

Albarran, S Ayaon; Simoens, Christian; Winkel, Nele Van De; Costa, Pierre Mendes Da; Thill, V.

doi:10.1080/00015458.2009.11680522

Cited by 16 publications

(5 citation statements)

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“…The length of intensive care unit (ICU) stay was also significantly ( p = 0.003) shorter in the LG [LG 0 days (0–2); OG 1 day (0–12)]. Significant advantages associated with a laparoscopic procedure were observed for the return to normal bowel function (measured as a clinical parameter by bowel sounds; LG 3 days [2–4]; OG 4 days [2–9]; p < 0.0001), the return to normal diet (LG: 3 days [2–6]; OG 4 days [2–10]; p = 0.001), and in the postoperative continuous use of analgesics (non‐steroidal anti‐inflammatory drug [NSAID] or morphine preparations) in days (LG 7 days [6–10]; OG 12 days [6–30]; p < 0.0001). The length of the overall hospital stay (LOS) was also significantly shorter in the LG, with a median of 9 days (7–14) compared with 15 days (8–163) in the OG ( p < 0.0001).…”

Section: Resultsmentioning

confidence: 99%

“…The length of the interval before Hartmann reversal is determined by the underlying disease itself and the physical status of the patient [12]. A review of the literature revealed that most surgeons recognize an interval of 15-17 weeks after the initial Hartmann procedure as ideal for the most common indication, perforated sigmoid diverticulitis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic Versus Open Reversal of a Hartmann Procedure: A Single‐Center Study

Zimmermann¹,

Hoffmann²,

Laubert³

et al. 2014

World j. surg.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoscopic Versus Open Reversal of a Hartmann Procedure: A Single‐Center Study

Zimmermann¹,

Hoffmann²,

Laubert³

et al. 2014

World j. surg.

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“…Restoring intestinal continuity after Hartmann's operation is a difficult operation that is associated with a high morbidity rate, with anastomotic leakage rates ranging from 4% to 16% and an operative mortality reported as high as 10% [7][8][9][10].…”

Section: Reversal Of Hartmann's Proceduresmentioning

confidence: 99%

The Evolution of Minimally Invasive Techniques in Restoration of Colonic Continuity

Clermonts¹,

Stassen²,

Zimmerman³

2017

Laparoscopic Surgery

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Restoration of bowel continuity after Hartmann's procedure is considered technically challenging and is associated with high morbidity and mortality. This is the main reason why restoration of intestinal continuity is often not attempted. Over the past decade, considerable international experience has gained on this topic with new minimally invasive techniques being developed. This review details the evolution of minimally invasive techniques in restoration of colonic continuity after Hartmann's procedure. A comprehensive search of PubMed and Embase was done. Different restoration modalities were included. Eight studies, from six different countries, in which multiport laparoscopic restoration of continuity was compared to conventional open restoration of bowel continuity, were included. In the total of 254 patients, continuity was restored laparoscopically compared with 255 patients in which continuity was performed in open fashion. Restoration of bowel continuity via trephine access was also reported; three studies including 37 patients were included in this review. Single-port restoration of bowel continuity after Hartmann's procedure is a natural evolution of multiport laparoscopy and trephine access. Six studies reporting on single-port reversal of Hartmann's procedure were included with a total of 75 patients. Single-port access in combination with a transanal approach has also been reported; however, data are extremely limited as there is only one study in the published literature. Success of restoration of bowel continuity with less morbidity and mortality has been demonstrated throughout the evolution of the different surgical techniques. In this review advantages of different approaches for restoration of bowel continuity after Hartmann's procedure are discussed. Furthermore, surgical techniques are described, pictorial guides are added for some techniques, and flowcharts are given for easy use during clinical decision-making.

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“…ASA score consists of five classes (I to V) as follows: in class I, the patient is completely fit for surgical operation, class II patient has only mild systemic disease, class III patient has severe systemic disease that is not disabling, class IV patient has severe systemic disease that confers impending threat to life, class V a severe morbid condition that the patient is not anticipated to live 24 hours with or without surgery [ 7 ]. Reversal of Hartmann’s procedure and restoration of colonic continuity was associated with relatively high morbidity and mortality rates [ 8 , 9 ]. Reversal of Hartmann’s procedure could be done by either open surgery approach or laparoscopic approach [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Correlation between ASA Grade with reversal of Hartmann’s procedure – a retrospective study

et al. 2021

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Hartmann’s procedure involves resecting the rectosigmoid colon, closure of the distal rectal stump, and forming an end colostomy for complicated left colon diverticulitis or malignancy. Recovery from the initial operation can, in a second stage, be followed by a reversal stage with the restoration of bowel continuity. This study aimed to assess the reversal rate and its correlation with demographic data, ASA grade, and length of hospital stay. All patients who underwent Hartmann’s emergency procedure from 2014 to 2018 at Lewisham and Greenwich hospital were enrolled in this retrospective study. Data was collected from the inpatient electronic files and NELA (UK National Laparotomy Audit). 118 patients were included in the study, with 57.6% females and a median age of patients of 69 years (range 35–91). Findings of the study indicate that the most common indications for Hartmann’s procedure were diverticular complications 60% (n=71) and benign perforated sigmoid or rectosigmoid cancer 16% (n=19). The average length of hospital stay was 24 days (range n=2 – 212 days). The reversal rate was 34.9% (41/118 cases). No significant difference was observed between gender and length of hospital stay in relation to the reversal rate while there was a significant correlation between age and ASA grade in relation to reversal rate; the calculated P values were recorded as (<0.000) and (<0.009) respectively. Our results show that the highest reversal rate was observed in younger and fitter (I–II) ASA grade patients. The most common medical complication from reversal of Hartmann’s procedure was an anastomotic leak (n=6, 16.7%). Reversal rate of Hartmann’s procedure was 34.9%. The average timeframe for reversal was within 18–20 months. There was a significant correlation between age and ASA grade in relation to reversal rate.

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Restoration of Digestive Continuity after Hartmann’s Procedure: ASA Score is a Predictive Factor for Risk of Postoperative Complications

Abstract: The RDC is an intervention performed safely after a 3 to 5-month delay with acceptable morbidity and negligible mortality. The ASA score is a determining factor for the risk of complications (p < 0.05).

Cited by 16 publications

References 0 publications

Laparoscopic Versus Open Reversal of a Hartmann Procedure: A Single‐Center Study

Laparoscopic Versus Open Reversal of a Hartmann Procedure: A Single‐Center Study

The Evolution of Minimally Invasive Techniques in Restoration of Colonic Continuity

Correlation between ASA Grade with reversal of Hartmann’s procedure – a retrospective study

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