Feasibility and morbidity of reversal of Hartmann's

Abstract

Objective: Reversal of Hartmann's is a major surgical procedure and associated with substantial morbidity and mortality.

Method: This study retrospectively analysed the data at a single centre over an eight-year period to assess the clinical results and morbidity of reversal of Hartmann's.

Results: One hundred and ten Hartmann's procedures were performed during the period. Only 66 (61%) of patients had a reversal. Advanced age and comorbidity were the primary reasons for not reversing. Complications among the 66 patients (36 males and 30 females) who underwent reversal occurred in 26 (41%). There were no deaths. Patients who underwent reversal were ASA 2 (60%), ASA 3 (25%) and ASA 4 (4.6%). Univariate analysis demonstrated a significant association between complications following reversal and ASA grade (P =0.01), and hypertension (P = 0.03) There was no correlation between the patient variables and anastomotic leakage. Multiple logistic regression analysis showed a significant influence of hypertension, smoking and ASA grade on complications.

Conclusions: About 40% of patients who undergo Hartmann's procedure will not have a reversal. Reversal is a feasible operation for selected patients, but there is a high complication rate.