#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

The Role of Hartmann’s Procedure and Options for its Reconstruction at the Present Time


Authors: M. Huťan;  V. Hájovský;  M. Huťan ml. *;  J. Rybár
Authors‘ workplace: IV. chirurgická klinika LF UKo a FNsP Bratislava, Slovenská republika prednosta: doc. MUDr. Martin Huťan, CSc. ;  II. chirurgická klinika LF UKo a FNsP Bratislava, Slovenská republika prednosta: doc. MUDr. Ján Škultéty, CSc. *
Published in: Rozhl. Chir., 2010, roč. 89, č. 5, s. 293-297.
Category: Monothematic special - Original

Overview

Introduction:
Hartmann operation (rectosigmal resection, blind closure of rectum and terminal sigmostomy) is one of the options of treatment of pathology of left colon. Despite great effort to treat such surgical conditions with primary anastomosis, Hartmann’s operation is in selected cases preferred. It requires, though, secondary reconstruction, which might be associated with complications.

Aim of the study:
Analyzing patients after Hartmann’s operations with evaluation of risk, complications, morbidity and mortality.

Material and methods:
Authors analyzed group of 61 patients, which were operated on in years 2004–2008, with Hartmann’s operation performed. They state surgical conditions, Hinchey classification, risk rate according to ASA and MPI, and concommitant diseases.

Results:
Of complications, most frequent were wound infections and pneumonia, nine patients (14.7%) died. In presented time period, nineteen reconstructions after Hartmann’s procedure were performed. Morbidity in this category was high, no death was noted. Authors analyze factors, that influence decision of operation for pathology of left colon and possibilities of reconstruction after Hartmann’s procedure.

Conclusion:
Authors state, that Hartmann’s procedure has still its place in urgent operations. Reconstruction in feasible in high percentage of patients with minimal mortality, difficulty lies with high morbidity.

Key words:
Hartmann’s procedure – Mannheim Peritonitis Index – complications – reconstruction – Hinchey


Sources

1. Hotouras, A. Henri Hartmann and his operation. Grand Rounds, Vol 8 p. L1-L3 in 2008 e-MED Ltd.

2. Constantinides, V. A., Tekkis, P. P., Athanasiou, T., Aziz, O., Purkayastha, S., Remzi, F. H., Fazio, V. W., Aydin, N., Darzi, A., Senapati, A. Primary resection with anastomosis v.s. Hartmann‘s procedure in nonelective surgery for acute colonic diverticulitis: A systematic review. Dis. Colon Rectum, 2006, 49: 966–981.

3. Salem, L., Flum, D. R. Primary anastomosis or Hartmann‘s procedure for pacients with diverticular peritonitis? A systematic review. Dis. Colon Rectum, 2004, 47: 1953–1964.

4. Regenet, N., Pessaux, P., Hennekinne, S., Lermite, E., Tuech, J. J., Brehant, O., Arnaud, J. P. Primary anastomosis after intraoperative colonic lavage v. s. Hartmann‘s procedure in generalized peritonitis complicating diverticular disease of the colon. Int. J. Colorectal Dis., 2003, 18: 503–507.

5. Pautrat, K., Bretagnol, F., Huten, N., de Calan, L. Acute diverticulitis in very young patients : a frequent surgical management. Dis. Colon Rectum, 2006, 50: 472–477.

6. Oomen, J. L. T., Cuesta, M. A., Engel, A. F. Reversal of Hartmann‘s procedure after surgery for complications of diverticular disease of the sigmoid colon is safe and posible in most patients. Dig. Surg., 2005, 22: 419–425.

7. Roque-Castellano, C., Marchena-Gomez, J., Hemmersbach-Miller, M., Acosta-Merida, A., Rodrigues-Mendes, A., Fariňa-Castro, R., Hernandez-Romero, J. Analysis of the factors related to the decision of restoring intestinal continuity after Hartmanns procedure. Int. J. Colorectal Dis., 2007, 22: 1091–1096.

8. Hinchey, E. J., Schaal, P. G. H., Richards, M. B. Treatment of perforated diverticulitis of the colon. Adv. Surg.,1978, 12: 85–105.

9. Linder, M. M., Wacha, H., Feldmann, U., Wesch, G., Streifensand, R. A., Gundlach, E. Der Mannheimer Peritonitis – Index. Ein Instrument zur intraoperativen Prognose der Peritonitis. Chirurg, 1987, 58: 84–92.

10. Vermeulen, J., Akkersdijk, G. P., Gosselink, M. P., Hop, W. C. J., Mannaerts, G. H., va der Harst, E., Coene, P-P. L. O., Weidema, W. F., Lange, J. F. Outcome after emergency surgery for acute perforated diverticulitis in 200 cases. Dig. Surg., 2007, 24: 361–366.

11. Leong, Q. M., Koh, D. C., Ho, C. K. Emergency Hartmann‘s procedure: morbidity, mortality and reversal among Asians. Tech. Coloproctol., 2008, 12: 21–25.

12. Zorcolo, L., Lovotta, I., Carlomagno, N., Bartollo, D. C. Toward lowering morbidity, mortality and stoma formation in emergency colorectal surgery: the role of specialization. Dis. Colon Rectum, 2003, 46: 1461–1467.

13. Meyer, F., Marusch, F., Koch, A., Meyer, L., Fuehrer, S., Kockerling, F., Lippert, H., Gastinger, I. Emergency operation in carcinomas of the left colon: value of Hartmann‘s procedure. Tech. Coloproctol., 2004, 8: S226–S229.

14. Gooszen, A. W., Tollenaar, R. A., Geelkerken, R. H., Smeets, H. J., Bemelman W. A., van Schardenburgh, P., Gooszen, H. G. Prospective study of primary anastomosis following sigmoid resection for suspected acute complicated diverticular disease. Br. J. Surg., 88, 2001, 88: 693–697.

15. Gonzales, O. A., Duran, R. O., Avalos, G. J., Herrera, C. G., Orozco, M. A. Hartmann‘s procedure. Institutional experience with a 92 consecutive cases. Rev. Gastroenterol. Mex., 1999, 64 (3): 127–139.

16. Khosraviani, K., Campbell, W. J., Parks, T. G., Irwin, S. T. Hartmann‘s procedure revised. Eur. J. Surg., 2000., 166 (11): 878–881.

17. Allbarran, S. A., Simoens, C., Takeh, H., Mendes, D. S. Restoration of digestive continuity after Hartmann‘s procedure. Hepatogastroenterology, 2004, 51(58): 1045–1049.

18. Pearce, N. W., Scott, S. D., Karran, S. J. Timing and method of reversal of Hartmanns procedure. Br. J. Surg., 1992, 79(8), 839–841.

19. Aydin, H. N., Remzi, F. H., Tekkis, P. P., Fazio, V. W. Hartmann‘s reversal is associated with high postoperative adverse events. Dis. Colon Rectum, 48, 2005, 48: 2117–2126.

20. Banerjee, S., Leather, A. J. M., Rennie, J. A., Samano, N., Gonzales, J. G., Papagrigoriadis, S. Feasibility and morbidity of reversal of Hartmann‘s. Colorectal Disease, 7, 2005,7: 454–459.

21. Slawik, S., Dixon, A. R. Laparoscopic reversal of Hartmann‘s rectosigmoidectomy. Colorectal Disease, 2007, 10: 81–83.

Labels
Surgery Orthopaedics Trauma surgery
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#