[Evolution of indications for Hartmann's operation. Reflexions on a series of 160 cases]. / Evolution des indications de l'opération de Hartmann. Réflexions à propos d'une série de 160 observations.

The authors report the results and indications of 160 Hartmann's procedures performed over a period of 15 years. Between 1978 and 1992, 160 patients (90 males, 70 females), with a mean age of 72, underwent Hartmann's procedure for rectosigmoid carcinoma in 55% of cases, for complications of sigmoid diverticulitis in 36% and for other lesions in 14%. Hartmann's procedure was performed either electively (42%) or as an emergency (58%) with a mortality of 6% and 32% respectively. The majority of complications included wound infections or intraperitoneal abscess, and the overall morbidity was 30%. Re-establishment of bowel continuity was performed in 30.7% of patients, most of whom had been initially operated as an emergency for a benign lesion. These 160 cases of Hartmann's procedure represent 27% of the 590 operations performed during the same period as an emergency or electively for rectosigmoid lesion. Hartmann's procedure remains a most effective technique for emergency surgery for benign or malignant lesions with colonic septic complications, and is also indicated electively for palliative treatment of rectosigmoid carcinoma.

[Thoughts on the treatment of diverticular sigmoiditis. Apropos of 191 cases]. / Rèflexions sur le traitement de la sigmoïdite diverticulaire.

Between January 1, 1984 and December 31, 1993, we treated 191 patients with diverticular sigmoiditis. Three groups of patients were distinguished in this retrospective study. In group 1, there were 108 patients (56.5%) who were referred by gastroenterologists after one or two episodes of sigmoiditis and who underwent planned exeresis. In group 2, there were 42 patients (21.9%) in whom the sigmoiditis was revealed by a complication and who underwent and emergency procedure. In group 3, there were 41 patients (21.6%) over 70 years of age with major risk for anesthesia and/or surgery who were treated medically. Mortality, morbidity and duration of hospital stay were analyzed by group. Operative mortality was 0.92, 19 and 7.3% respectively. Operative morbidity among the survivors was 21 and 35% in groups 1 and 2 respectively. Mean hospital stay varied from 15 days for planned procedures up to 20 days for emergency surgery. It was 9 days in group III. These findings recall the need for radical preventive exeresis for diverticular sigmoiditis.