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. 2009 Dec;13(12):2260-7.
doi: 10.1007/s11605-009-0987-3. Epub 2009 Sep 2.

Routine evaluation of the distal colon remnant before Hartmann's reversal is not necessary in asymptomatic patients

Nikiforos Ballian  1 , Barbara Zarebczan, Alejandro Munoz, Bruce Harms, Charles P Heise, Eugene F Foley, Gregory D Kennedy
Affiliations

Routine evaluation of the distal colon remnant before Hartmann's reversal is not necessary in asymptomatic patients

Nikiforos Ballian et al. J Gastrointest Surg. 2009 Dec.

Abstract

Background: Reversal of Hartmann's is a common surgical procedure. Routine preoperative evaluation of the distal colonic/rectal remnant (DCRR) with contrast and/or endoscopic studies is frequently performed despite lack of evidence to support this practice. We hypothesize that asymptomatic patients can safely undergo Hartmann's reversal without preoperative DCRR evaluation.

Methods: Adult patients undergoing reversal of Hartmann's at a single institution were retrospectively identified. Operative characteristics and outcomes in patients with and without preoperative DCRR evaluation were compared.

Results: Between 1993 and 2008, 203 patients underwent reversal of Hartmann's at a tertiary referral center. Sixty-eight patients (33%) did not undergo preoperative DCRR evaluation and had comparable demographic characteristics, comorbidities, DCRR length, and perioperative outcomes to 135 patients who underwent preoperative contrast and/or endoscopic studies. After evaluation, 125 (93%) patients had normal findings, seven (5%) patients had abnormal studies that did not impact their management, and three (2%) patients underwent additional procedures.

Conclusion: Hartmann's reversal without previous DCRR evaluation is acceptable in selected asymptomatic patients, without increased risk of complications.

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