title: Routine evaluation of the distal colon remnant before Hartmann's reversal is not necessary in asymptomatic patients.
abstract: BACKGROUND
  Reversal of Hartmann's is a common surgical procedure. Routine preoperative evaluation of the distal colonic/rectal remnant (DCRR) with contrast and/or endoscopic studies is frequently performed despite lack of evidence to support this practice. We hypothesize that asymptomatic patients can safely undergo Hartmann's reversal without preoperative DCRR evaluation.
  
  
  METHODS
  Adult patients undergoing reversal of Hartmann's at a single institution were retrospectively identified. Operative characteristics and outcomes in patients with and without preoperative DCRR evaluation were compared.
  
  
  RESULTS
  Between 1993 and 2008, 203 patients underwent reversal of Hartmann's at a tertiary referral center. Sixty-eight patients (33%) did not undergo preoperative DCRR evaluation and had comparable demographic characteristics, comorbidities, DCRR length, and perioperative outcomes to 135 patients who underwent preoperative contrast and/or endoscopic studies. After evaluation, 125 (93%) patients had normal findings, seven (5%) patients had abnormal studies that did not impact their management, and three (2%) patients underwent additional procedures.
  
  
  CONCLUSIONS
  Hartmann's reversal without previous DCRR evaluation is acceptable in selected asymptomatic patients, without increased risk of complications.
authors.affiliation: Department of Surgery, University of Wisconsin, G4/701 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-7375, USA.
authors.forename: Nikiforos
authors.initials: N
authors.lastname: Ballian
authors.forename: Barbara
authors.initials: B
authors.lastname: Zarebczan
authors.forename: Alejandro
authors.initials: A
authors.lastname: Munoz
authors.forename: Bruce
authors.initials: B
authors.lastname: Harms
authors.forename: Charles P
authors.initials: CP
authors.lastname: Heise
authors.forename: Eugene F
authors.initials: EF
authors.lastname: Foley
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kennedy
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000000981:diagnostic imaging / Q000601:surgery*; D003113:Colonoscopy; D003125:Colostomy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies