[Colon recanalization after Hartmann's procedure. A challenge for the surgeon or a strategy to be changed?]. / La ricanalizzazione del colon dopo l'intervento di Hartmann. Un impegno per il chirurgo o una strategia da cambiare?

AIM: Restoration of colorectal continuity is the second step of the procedure originally described by H. Hartmann for the treatment of sigmoid colon cancers. It is a safe, but complex procedure, that needs a meticulous surgical technique and is associated with a significant morbidity in as many as 40% of cases. For this reason, many patients are not submitted to reversal of the colostomy. METHODS: The authors report their experience: 32 patients underwent colostomy closure after Hartmann's procedure during the last 8 years. RESULTS: The mortality rate was nil, but post-operative complications occurred in 12 patients (37.5%), namely: wound infection (11 patients) and anastomotic leak (2 patients). CONCLUSION: In light of this, it could be wiser to perform, in the patients affected with benign pathology, and in those affected with limited malignant pathology (T3), resection of the diseased segment of colon and primary anastomosis with temporary ileostomy, reserving Hartmann's procedure to patients unsuitable to one step treatment because of their poor general and local conditions.