Analysis of the factors related to the decision of restoring intestinal continuity after Hartmann's procedure.
OBJECTIVE
Hartmann's operation is widely used for the surgical treatment of complicated left colonic disease. However, many patients never undergo reanastomosis. This study analyzes the factors related to the decision of restoring intestinal continuity.


METHODS
Between 1997 and 2004, 162 patients underwent Hartmann's operation in our institution. Age, sex, anesthetic risk evaluation (ASA score), underlying disorder (neoplastic vs non-neoplastic), prevalence of colonic reconstruction, as well as postoperative length of hospital stay, perioperative mortality and complications due to the latter procedure were analyzed. Long-term survival was also recorded.


RESULTS
Patients' mean age was 68.7 years (SD +/- 14.9); 104 were men (64.2%) and 58 were women (35.8%). Hartmann's operation mortality was 20.4%. Forty-two colonic continuity restorations were performed (25.9%). Mean time until reconstruction procedure was 13.3 months. There were no deaths (mortality 0%), but 23 cases suffered complications (54.8%). No suture dehiscence was observed. Estimated probability of being alive 1, 3, and 5 years after the initial operation was 64.1, 50.4, and 44.3%, respectively. Significant univariate predictors of reversal were male sex (p = 0.003), non-neoplastic disorder (p = 0.004), younger age (p = 0.001) and lower anesthetic risk (p = 0.009). In the multivariate analysis, independent predictive factors were age (OR: 0.94; 95% CI: 0.91-0.98), non-neoplastic disorder (OR: 0.16; 95% CI: 0.05-0.45), and lower anesthetic risk (OR: 0.22; 95% CI: 0.08-0.58).


CONCLUSIONS
Hartmann's procedure implies a high mortality and a low percentage of restoration of intestinal continuity. In selected patients, closure of Hartmann's colostomy is a safe procedure, but has a significant morbidity.
Roque-Castellano
Cristina
C
Department of General Surgery, University Hospital Gran Canaria Dr. Negrin, Bco. de la Ballena s/n, 35020 -, Las Palmas G.C., Spain. croque77@hotmail.com
Marchena-Gomez
Joaquin
J
Hemmersbach-Miller
Marion
M
Acosta-Merida
Asuncion
A
Rodriguez-Mendez
Alvaro
A
Fariña-Castro
Roberto
R
Hernandez-Romero
Juan
J
D003082:Colectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D003106:Colon / Q000601:surgery*; D012809:Colon, Sigmoid / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects / Q000401:mortality; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D041981:Gastrointestinal Tract / Q000503:physiopathology*; D005772:Gastrointestinal Transit; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies