title: Reversal of Hartmann's procedure following acute diverticulitis: is timing everything?
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.
authors.affiliation: Surgical Professorial Unit, Department of Surgery, Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland. fjfleming@rcsi.ie
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
authors.forename: Peter
authors.initials: P
authors.lastname: Gillen
mesh_terms: D000208:Acute Disease; D000368:Aged; D003125:Colostomy; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004238:Diverticulitis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010359:Patient Readmission; D013997:Time Factors; D016896:Treatment Outcome