Reversal of Hartmann's procedure following acute diverticulitis: is timing everything?

Hdl Handle:
http://hdl.handle.net/10147/207364
Title:
Reversal of Hartmann's procedure following acute diverticulitis: is timing everything?
Authors:
Fleming, Fergal J; Gillen, Peter
Affiliation:
Surgical Professorial Unit, Department of Surgery, Our Lady of Lourdes Hospital, , Drogheda, Co Louth, Ireland. fjfleming@rcsi.ie
Citation:
Int J Colorectal Dis. 2009 Oct;24(10):1219-25. Epub 2009 Jun 5.
Journal:
International journal of colorectal disease
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207364
DOI:
10.1007/s00384-009-0747-6
PubMed ID:
19499234
Abstract:
BACKGROUND: Patients who undergo a Hartmann's procedure may not be offered a reversal due to concerns over the morbidity of the second procedure. The aims of this study were to examine the morbidity post reversal of Hartmann's procedure. METHODS: Patients who underwent a Hartmann's procedure for acute diverticulitis (Hinchey 3 or 4) between 1995 and 2006 were studied. Clinical factors including patient comorbidities were analysed to elucidate what preoperative factors were associated with complications following reversal of Hartmann's procedure. RESULTS: One hundred and ten patients were included. Median age was 70 years and 56% of the cohort were male (n = 61). The mortality and morbidity rate for the acute presentation was 7.3% (n = 8) and 34% (n = 37) respectively. Seventy six patients (69%) underwent a reversal at a median of 7 months (range 3-22 months) post-Hartmann's procedure. The complication rate in the reversal group was 25% (n = 18). A history of current smoking (p = 0.004), increasing time to reversal (p = 0.04) and low preoperative albumin (p = 0.003) were all associated with complications following reversal. CONCLUSIONS: Reversal of Hartmann's procedure can be offered to appropriately selected patients though with a significant (25%) morbidity rate. The identification of potential modifiable factors such as current smoking, prolonged time to reversal and low preoperative albumin may allow optimisation of such patients preoperatively.
Language:
eng
MeSH:
Acute Disease; Aged; Colostomy; Comorbidity; Digestive System Surgical Procedures/*methods; Diverticulitis/complications/*surgery; Female; Humans; Male; Middle Aged; Patient Admission; Patient Readmission; Time Factors; Treatment Outcome
ISSN:
1432-1262 (Electronic); 0179-1958 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorFleming, Fergal Jen_GB
dc.contributor.authorGillen, Peteren_GB
dc.date.accessioned2012-02-01T10:21:38Z-
dc.date.available2012-02-01T10:21:38Z-
dc.date.issued2012-02-01T10:21:38Z-
dc.identifier.citationInt J Colorectal Dis. 2009 Oct;24(10):1219-25. Epub 2009 Jun 5.en_GB
dc.identifier.issn1432-1262 (Electronic)en_GB
dc.identifier.issn0179-1958 (Linking)en_GB
dc.identifier.pmid19499234en_GB
dc.identifier.doi10.1007/s00384-009-0747-6en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207364-
dc.description.abstractBACKGROUND: Patients who undergo a Hartmann's procedure may not be offered a reversal due to concerns over the morbidity of the second procedure. The aims of this study were to examine the morbidity post reversal of Hartmann's procedure. METHODS: Patients who underwent a Hartmann's procedure for acute diverticulitis (Hinchey 3 or 4) between 1995 and 2006 were studied. Clinical factors including patient comorbidities were analysed to elucidate what preoperative factors were associated with complications following reversal of Hartmann's procedure. RESULTS: One hundred and ten patients were included. Median age was 70 years and 56% of the cohort were male (n = 61). The mortality and morbidity rate for the acute presentation was 7.3% (n = 8) and 34% (n = 37) respectively. Seventy six patients (69%) underwent a reversal at a median of 7 months (range 3-22 months) post-Hartmann's procedure. The complication rate in the reversal group was 25% (n = 18). A history of current smoking (p = 0.004), increasing time to reversal (p = 0.04) and low preoperative albumin (p = 0.003) were all associated with complications following reversal. CONCLUSIONS: Reversal of Hartmann's procedure can be offered to appropriately selected patients though with a significant (25%) morbidity rate. The identification of potential modifiable factors such as current smoking, prolonged time to reversal and low preoperative albumin may allow optimisation of such patients preoperatively.en_GB
dc.language.isoengen_GB
dc.subject.meshAcute Diseaseen_GB
dc.subject.meshAgeden_GB
dc.subject.meshColostomyen_GB
dc.subject.meshComorbidityen_GB
dc.subject.meshDigestive System Surgical Procedures/*methodsen_GB
dc.subject.meshDiverticulitis/complications/*surgeryen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshPatient Admissionen_GB
dc.subject.meshPatient Readmissionen_GB
dc.subject.meshTime Factorsen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titleReversal of Hartmann's procedure following acute diverticulitis: is timing everything?en_GB
dc.contributor.departmentSurgical Professorial Unit, Department of Surgery, Our Lady of Lourdes Hospital, , Drogheda, Co Louth, Ireland. fjfleming@rcsi.ieen_GB
dc.identifier.journalInternational journal of colorectal diseaseen_GB
dc.description.provinceLeinster-

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