An interesting perspective exists around the dichotomous nature of surgical emergencies
resulting in a Hartmann's procedure and the elective decision to pursue subsequent
reversal. The index operation is frequently emergent in the setting of a threat to
life from sepsis due to colonic perforation, obstruction, or ischemia. The etiology
of these conditions is broad, including benign or malignant disease, as well as trauma.
In the end, the patient undergoes a critical operation resulting in the creation of
a colostomy. The benefit of the index case nearly always outweighs the risk given
the often life-threatening indication. The second procedure is quite the opposite.
Generally, the patient has recovered and the reversal of their colostomy is purely
elective. The risks with the creation of a new anastomosis, including anastomotic
failure and intra-abdominal sepsis, essentially re-creates the indication for which
the index surgery was performed. Aside from patients with severe body image issues
related to the ostomy or those with poorly functioning stomas, there is no disease
process to be addressed. The only purpose of the second operation is to allow the
patient to defecate out of their anus as opposed to their abdominal wall. Therefore,
the preoperative considerations should focus on the level of risk acceptable to achieve
this goal.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hartmann's reversal is associated with worse outcomes compared to elective left colectomy: a NSQIP analysis of 36,794 cases.Am J Surg. 2022; 224: 1351-1355
- Is previous postoperative infection an independent risk factor for postoperative infection after second unrelated abdominal operation?.J Appl Comput Sci. 2022; 235: 285-292
- Hartmann's procedure vs primary anastomosis with diverting loop ileostomy for acute diverticulitis: nationwide analysis of 2,729 emergency surgery patients.J Appl Comput Sci. 2019; 229: 48-55
- Long-term outcomes of Hartmann's procedure versus primary anastomosis for generalized peritonitis due to perforated diverticulitis: follow-up of a prospective multicenter randomized trial (DIVERTI).Int J Colorectal Dis. 2021; 36: 2159-2164
- Hartmann's procedure, reversal and rate of stoma-free survival.Ann R Coll Surg Engl. 2018; 100: 301-307
Article info
Publication history
Published online: September 12, 2022
Accepted:
September 3,
2022
Received:
September 1,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.