CLINICAL OUTCOMES OF REVERSAL OF HARTMANN’S PROCEDURE

Authors

DOI:

https://doi.org/10.11603/ijmmr.2413-6077.2022.1.13043

Keywords:

Hartmann’s procedure, reversal, anastomotic leakage

Abstract

Background. Reversal of Hartmann’s procedure (HP) is one of the most complex surgical interven­tions in abdominal surgery with high morbidity rates of up to 58% in the patients after HP and mortality of up to 3.6%.

Objective. This was a retrospective observational study to analyze the Hartmann’s reversal (HR) outcomes.

Methods. The study involved 31 patients (16 males and 15 females), average age 59.6±10.31 (range 26-80), who underwent HR at Ternopil Regional Hospital in 2010 - 2021. The reasons for the HP were: cancer in 20 (64.5%) cases, perforation of the diverticulum – 6 (19.3%), traumatic rupture – 3 (9.7%) and Crohn’s disease - 2 (6.4%) cases.

Results. Median time from Hartmann’s procedure to reversal was 11.13±9.24 months (interval 3-38). Intraoperative time was 210.33±56.91 minutes (range 120-330). HR was performed in 30 (96.8 %) patients. Dense pelvic adhesions of the stump of the rectum was diagnosed in 13 (41.9%) patients. Hand-sewn anastomosis was performed for 22 (71%) patients, stapler anastomosis – 4 (12.9%), pull-through technique – 3 (9.7%) patients. AL occurred in 3 (9.7%) patients on the 15th, 23rd and 35th postoperative days. pseudomembranous colitis was diagnosed in 2 (6.4%) patients with AL. The mortality rate was 1 (3.3%) as a result of septic complications due to AL; this case was not operated by a colorectal surgeon due to administrative issue in the hospital.

Conclusions. Hartmann’s reversal is still one of the most difficult operations in colorectal surgery with high incidence of postoperative complications. Sound selection of patients with low comorbidity and in suitable time period is crucial for successful HR.

Author Biographies

I. Ya. Dzyubanovskyy, I. HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE.

Professor, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine

 

A. D. Bedeniuk, I. HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE.

Professor, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine

S. Y. Grytsenko, I. HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE.

Assistant Professor, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine

References

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Published

2022-09-05

How to Cite

Dzyubanovskyy, I. Y., Bedeniuk, A. D., & Grytsenko, S. Y. (2022). CLINICAL OUTCOMES OF REVERSAL OF HARTMANN’S PROCEDURE. International Journal of Medicine and Medical Research, 8(1), 44–47. https://doi.org/10.11603/ijmmr.2413-6077.2022.1.13043

Issue

Vol. 8 No. 1 (2022): International Journal of Medicine and Medical Research

Section

Surgical Diseases

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