Reversal of Hartmann’s Procedure after Surgery for Complications of Diverticular Disease of the Sigmoid Colon Is Safe and Possible in Most Patients

Abstract

Background: Although evidence is growing that most patients who need an operation for diverticular disease of the sigmoid colon can be treated by a single-stage procedure, a two-stage procedure will still be necessary in some patients because of significant sepsis or technical difficulties. The outcomes of 65 patients who underwent secondary restoration after a Hartmann procedure for complicated diverticulitis were studied and the factors leading to complications and mortality were identified. Patients and Methods: Of 91 patients, in a consecutive 12-year period, whose primary operation was a Hartmann procedure, 72 survived longer than 3 months after discharge. Sixty-five underwent an attempted reversal of the Hartmann procedure. The POSSUM scores were calculated in all patients as well as the morbidity and mortality rates. Results: In 63 (96.9%) patients the bowel continuity could be restored with a morbidity of 38.5% and a mortality of 3.1%. The POSSUM and p-POSSUM scores adequately predicted the mortality in this series. Conclusion: This series shows that when surgical treatment for complicated diverticular disease of the sigmoid colon is necessary, the Hartmann procedure is still a valid indication. In a high percentage of patients the Hartmann procedure could be restored with a low mortality.

A retrospective case note review of laparoscopic versus open reversal of Hartmann’s procedure

“…12,13 In this review, the reversal rate was in line with previous UK studies, 6,8 at 21%. This is an improvement on the 1992…”

Laparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control Sigma trial

“…Remarkably, only three (30%) of these temporary ostomies were closed. This number seems low compared with the 90% reversal after Hartmann's procedure presented by Oomen et al [13]. Other series present reversal rates of 31-85% [14,15].…”

Use of Hartmann’s procedure in England

“…Further, the mean age of patients undergoing Hartmann's in this series (72 years) is higher than in other large series [10,19] (69 and 68.7 years respectively) suggesting that comorbidity may have played a role in the lower reversal rate. Reversal of Hartmann's procedure itself has been extensively studied for its safety [20], morbidity [11] and effect of timing on outcome [12,21,22]. As with other series, on univariate analysis, younger age, male sex, a benign diagnosis, lower Charlson's comorbidity score, emergency admission and a noncolorectal surgeon being responsible for the initial Hartmann's procedure were found to be associated with a reversal.…”