Reversal of Hartmann's procedure following acute diverticulitis: is timing everything?
AffiliationSurgical Professorial Unit, Department of Surgery, Our Lady of Lourdes Hospital, , Drogheda, Co Louth, Ireland. email@example.com
Digestive System Surgical Procedures/*methods
MetadataShow full item record
CitationInt J Colorectal Dis. 2009 Oct;24(10):1219-25. Epub 2009 Jun 5.
JournalInternational journal of colorectal disease
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.
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