Factors affecting reversal following Hartmann's procedure: experience from two district general hospitals in the UK

Abstract

Purpose: Restoration of gastrointestinal continuity following Hartmann's procedure is a challenging task associated with significant morbidity and mortality. New strategies to avoid a stoma are not readily available in general hospitals. Knowledge of the factors related to reversal is required to develop treatment strategies and counsel patients realistically. The present study was conducted to determine the reversal rate and factors affecting Hartmann's reversal in our practice.

Methods: This study retrospectively reviewed the medical records of patients who underwent Hartmann's procedure and its reversal in two United Kingdom District Hospitals between January 1996 and December 2005.

Results: Case notes from 184 patients were reviewed. Hartmann's procedure was reversed in 51 (34.7%) of the surviving patients, with a complication rate of 37.3% and no mortality. Reversal of Hartmann's procedure was significantly related to patient age (P < 0.001), mode of admission (P = 0.003), American Society of Anesthesiologists grading (P = 0.003), Dukes' staging (P = 0.003), benign pathology (P = 0.001), and extracolonic cancer (P = 0.023).

Conclusions: Despite the challenging nature of Hartmann's reversal, colostomy closure can be achieved without mortality in a district general hospital. Familiarity with the factors associated with reversal should enable a genuine discussion with patients regarding reversal.