Hartmann's reversal after colonic perforation or anastomosis leakage, is it the same procedure? A retrospective study of 150 patients.

ABSTRACT

PURPOSE: The high morbidity rates reported might influence surgeons' decisions of whether to perform Hartmann's reversal (HR). Our aim was to report the results of HR after "primary" Hartmann's procedure (HP) or in redo surgery for failed anastomosis. METHODS: All patients operated between 2007 and 2015 were included. Data and postoperative course were obtained from a review of medical records and databases. RESULTS: One hundred fifty patients (age 60, range (20-91) years, 62% male) were included. Eighty-six patients (57%) were ASA ≥ 2. HP was mostly performed for diverticulitis (29.3%) and anastomotic leakage (24%). HR was possible in 145(97%) patients including six with previous failed attempt. Overall morbidity was 22.7% including 11.7% severe complications (Dindo 3-4). Operative blood loss and Charlson comorbidity index were the only significant risk factor for postoperative pelvic complications (p = 0.03; p = 0.0002, respectively). CONCLUSIONS: In a colorectal tertiary center, HR was feasible in 97% with a low morbidity and a 3.4% anastomotic leakage rate.