Reversal after Hartmann's procedure in patients with complicated sigmoid diverticulitis.
OBJECTIVE
Hartmann's procedure (HP) is commonly used for the emergency treatment of complicated sigmoid diverticulitis (CSD). It is intended to restore intestinal continuity; however, in practice, reversal is not carried out in all patients. It is important to know the frequency of reversal and the impact of patient-related factors on the decision for reversal.


METHODS
A retrospective study was conducted on all patients who underwent HP for CSD at a tertiary referral hospital between 1 May 2005 and 31 December 2010. We assessed the frequency of reversal over time and the prognostic factors affecting the decision for reversal.


RESULTS
Of 67 patients [median age 76 (interquartile range: 68-81) years] who had HP for CSD, 28 (42%) underwent reversal. The cumulative incidence of reversal after 48 weeks was 48% (95% CI: 36-62%). Reversal was less likely in elderly patients [hazard ratio (HR) per decade increase = 0.43; 95% CI: 0.26-0.71], with cardiac insufficiency or coronary heart disease (HR = 0.60; 95% CI: 0.26-1.40) and with preoperative immunosuppression or chemotherapy (HR = 0.31; 95% CI: 0.07-1.33). There was no apparent effect of these factors on mortality.


CONCLUSIONS
Approximately half of the patients having HP for CSD undergo reversal within 48 weeks of the initial operation. The finding that age, cardiac or coronary heart disease and preoperative immunosuppression or chemotherapy have an impact on the decision for reversal is relevant to healthcare professionals and patients.
Department of Surgery, University Hospital Basel, Basel, Switzerland.
G F
GF
Hess
Department of Surgery, University Hospital Basel, Basel, Switzerland.|Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
J
J
Schäfer
Department of Surgery, University Hospital Basel, Basel, Switzerland.
R
R
Rosenthal
Department of Surgery, University Hospital Basel, Basel, Switzerland.
C
C
Kettelhack
Department of Surgery, University Hospital Basel, Basel, Switzerland.
D
D
Oertli
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D012809:Colon, Sigmoid / Q000601:surgery*; D003125:Colostomy / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D057234:Preoperative Period; D011379:Prognosis; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies
Hartmann's procedure; Reversal; complicated sigmoid diverticulitis