Reversal of Hartmann's procedure after surgery for complications of diverticular disease of the sigmoid colon is safe and possible in most patients.
BACKGROUND
Although evidence is growing that most patients who need an operation for diverticular disease of the sigmoid colon can be treated by a single-stage procedure, a two-stage procedure will still be necessary in some patients because of significant sepsis or technical difficulties. The outcomes of 65 patients who underwent secondary restoration after a Hartmann procedure for complicated diverticulitis were studied and the factors leading to complications and mortality were identified.


METHODS
Of 91 patients, in a consecutive 12-year period, whose primary operation was a Hartmann procedure, 72 survived longer than 3 months after discharge. Sixty-five underwent an attempted reversal of the Hartmann procedure. The POSSUM scores were calculated in all patients as well as the morbidity and mortality rates.


RESULTS
In 63 (96.9%) patients the bowel continuity could be restored with a morbidity of 38.5% and a mortality of 3.1%. The POSSUM and p-POSSUM scores adequately predicted the mortality in this series.


CONCLUSIONS
This series shows that when surgical treatment for complicated diverticular disease of the sigmoid colon is necessary, the Hartmann procedure is still a valid indication. In a high percentage of patients the Hartmann procedure could be restored with a low mortality.
Department of Surgery, Zaans Medical Centre, Zaandam, The Netherlands. j.oome@chello.nl
J L T
JL
Oomen
M A
MA
Cuesta
A F
AF
Engel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery*; D012809:Colon, Sigmoid / Q000601:surgery*; D003125:Colostomy; D004238:Diverticulitis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D012810:Sigmoid Diseases / Q000601:surgery*