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Observational Study
. 2019 Nov;218(5):918-927.
doi: 10.1016/j.amjsurg.2019.02.025. Epub 2019 Feb 21.

Outcomes of Hartmann's procedure and subsequent intestinal restoration. Which patients are most likely to undergo reversal?

D Moro-Valdezate  1 , A Royo-Aznar  2 , J Martín-Arévalo  3 , V Pla-Martí  3 , S García-Botello  3 , C León-Espinoza  3 , M C Fernández-Moreno  3 , E Espín-Basany  2 , A Espí-Macías  4
Affiliations
Observational Study

Outcomes of Hartmann's procedure and subsequent intestinal restoration. Which patients are most likely to undergo reversal?

D Moro-Valdezate et al. Am J Surg. 2019 Nov.

Abstract

Background: Aim of the study was to describe characteristics and outcomes of Hartmann's procedure (HP) and subsequent intestinal restoration.

Methods: Retrospective study including all patients who underwent HP over a period of 16 consecutive years. We propose a classification and regression tree for a more accurate view of the relationship between the variables related to intestinal restoration and their weighting in the decision to reverse HP.

Results: 533 patients were included. Overall morbidity rate of HP was 53.5% and mortality 21.0%. Overall morbidity of the intestinal continuity reconstruction was 47.3% and mortality 0.9%. Patients with a benign disease, aged under 69 years and with low comorbidity, had an 84.4% probability of undergoing intestinal reconstruction.

Conclusions: HP is associated with high morbidity and mortality. Restoration of intestinal continuity involves minor, but frequent, morbidity and a low mortality rate. Age and comorbidities can decrease, and even override, the decision to reverse HP.

Keywords: Hartmann's procedure; Hartmann's reversal; Morbi-mortality.

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