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Kim DH, Lee KH. Safety of early Hartmann reversal during adjuvant chemotherapy in colorectal cancer: a pilot study. Front Surg 2023; 10:1243125. [PMID: 37829597 PMCID: PMC10566360 DOI: 10.3389/fsurg.2023.1243125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Most patients undergoing the Hartmann procedure for complicated colorectal cancer require chemotherapy because of their advanced status. Stoma created during the procedure is typically closed after the completion of postoperative chemotherapy. However, stomas can induce medical or surgical complications and disturb quality of life. This study aimed to evaluate the safety of Hartmann's reversal during postoperative chemotherapy. Methods We conducted a retrospective review of electronic medical records. Between 2017 and 2021, 96 patients underwent Hartmann reversal for after colorectal cancer surgery. Among them, the number of patients who underwent Hartmann procedure with radical resection of complicated colorectal cancer and Hartmann reversal during adjuvant chemotherapy was 13. The clinical, surgical, and pathological characteristics of the patients were evaluated. Results Eight and five patients had obstructions and perforations, respectively. Two patients with synchronous liver metastases underwent simultaneous liver resection and reversal simultaneously. Five and eight patients received adjuvant chemotherapy with capecitabine and FOLFOX, respectively. The median interval between the Hartmann procedure and reversal was 3.31 months (2.69-5.59). The median operative time for Hartmann's reversal was 190 min (100-335). The median hospital stay was 10 days (7-21). Four patients (30.8%) developed postoperative complications, and the rate of 3 or higher grade according to the Clavien-Dindo classification within 90 days postoperatively was 0%. Except for 1 patient who refused continuation of chemotherapy, 12 patients completed the planned chemotherapy. Median total duration of adjuvant chemotherapy was 6.78 months (5.98-8.48). There was no mortality. Conclusion Early Hartmann reversal during adjuvant chemotherapy is tolerable and safe in carefully selected patients. In particular, it can be used as a therapeutic option for patients with complicated colorectal cancer with synchronous resectable metastases.
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Affiliation(s)
| | - Kyung-Ha Lee
- Department of Colorectal Surgery, Chungnam National University College of Medicine and Hospital, Daejeon, Republic of Korea
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From Formation to Closure: Aggregate Morbidity and Mortality Associated With Defunctioning Loop Ileostomies. Dis Colon Rectum 2022; 65:1135-1142. [PMID: 34840304 DOI: 10.1097/dcr.0000000000002185] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Defunctioning loop ileostomies are used commonly, but there are significant morbidities. OBJECTIVE This study aimed to describe the morbidity and mortality associated with the formation and closure of defunctioning loop ileostomies. DESIGN This descriptive study is based on electronic health records and claims data. SETTINGS This study was conducted at academic and community hospitals in Ontario, Canada. PATIENTS Adult patients who had a low anterior resection with concurrent defunctioning loop ileostomy from 2002 to 2014 were included. MAIN OUTCOME MEASURES Outcomes of interest included 30-day major complications, acute kidney injury, transfusion, and deep space infection. The rate of ileostomy reversal and the percentage of permanent ostomies were also collected. RESULTS The cohort consists of 4658 patients who underwent low anterior resection with concurrent defunctioning loop ileostomy. The 30-day, 90-day, and 1-year mortality rates of these patients were 1.2%, 2.2%, and 5.1%. The rate of reoperation was 5.5%, the rate of hospital readmission was 13.4%, the rate of major complications was 28.5%, the rate of deep organ/space infection requiring percutaneous intervention was 5.2%, and the rate of acute kidney injury requiring hospitalization was 10.4%. Eighty-six percent had their ileostomy reversed, leaving 13.2% with a permanent ostomy. After ileostomy reversal, 30-day and 90-day mortality rates were 0.6% and 0.9%. The rate of major complications was 10.3%, bowel obstruction 7%, ventral hernia 10.5%, deep space infection 1.7%, and repeat operation 2.3%. LIMITATIONS This study is based on electronic health records and claims data and, thus, the accuracy of results depends on the accuracy of data administration' which can be variable across institutions. CONCLUSIONS Morbidity and mortality of defunctioning loop ileostomies are significant. One in 8 patients will have a permanent ostomy. See Video Abstract at http://links.lww.com/DCR/B810 . DESDE LA FORMACIN HASTA EL CIERRE AGREGADA MORBILIDAD Y MORTALIDAD ASOCIADA CON LAS ILEOSTOMAS EN ASA DERIVATIVA ANTECEDENTES:Las ileostomías en asa derivativa se utilizan con frecuencia, pero existen morbilidades importantes.OBJETIVO:Describir la morbilidad y mortalidad asociadas con la formación y cierre de ileostomías en asa derivativa.DISEÑO:Estudio descriptivo basado en historias clínicas electrónicas y datos de reclamaciones.ENTORNO CLINICO:Hospitales académicos y comunitarios en Ontario, Canadá.PACIENTES:Pacientes adultos sometidos a resección anterior baja con concurrente ileostomía en asa derivativa de 2002 a 2014.PRINCIPALES MEDIDAS DE VALORACION:Los resultados de interés incluyeron complicaciones mayores a los 30 días, lesión renal aguda, transfusión e infección del espacio profundo. También se recolectó la tasa de reversión de la ileostomía y el porcentaje de ostomías permanentes.RESULTADOS:La cohorte consistió de 4658 pacientes sometidos a resección anterior baja con concurrente ileostomía en asa derivativa. La mortalidad de estos pacientes, a treinta días, 90 días y un año, fue del 1,2%, 2,2% y 5,1%, respectivamente. La tasa de reintervención fue del 5,5%, el reingreso hospitalario fue del 13,4%, la complicación mayor fue del 28,5%, la infección profunda de órganos / espacios que requirieron intervención percutánea fue del 5,2%, y la lesión renal aguda que requirió hospitalización fue del 10,4%. Ochenta y seis por ciento tuvieron reversión de su ileostomía, dejando al 13.2% con una ostomía permanente. Después de la reversión de la ileostomía, la mortalidad a los 30 días y 90 días fue de 0,6% y 0,9%, respectivamente. La tasa de complicaciones mayores fue del 10,3%, obstrucción intestinal del 7%, hernia ventral del 10,5%, infección del espacio profundo del 1,7% y reintervención del 2,3%.LIMITACIONES:El estudio se basa en registros médicos electrónicos y datos de reclamos y, por lo tanto, la precisión de los resultados depende de la precisión en la administración de datos, que pueden variar entre instituciones.CONCLUSIONES:La morbilidad y la mortalidad de las ileostomías en asa derivativa son significativas. Uno de cada 8 pacientes tendrá una ostomía permanente. Consulte Video Resumen en http://links.lww.com/DCR/B810 . (Traducción-Dr. Fidel Ruiz Healy ).
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Factors Predicting the Reversal of Hartmann’s Procedure. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7831498. [PMID: 35832842 PMCID: PMC9273434 DOI: 10.1155/2022/7831498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/24/2022] [Indexed: 11/18/2022]
Abstract
Aim This paper investigates the risk factors preventing the reversal and nonreversal of Hartmann's procedure, as a surgical technique that has been performed in our clinic for ten years. Methods The study involved a ten-year Hartmann's procedure followed up at our center. The patients were divided into Hartmann reversal and nonreversal groups. Groups were examined in terms of age, gender, diagnosis, stage of malignancy, ASA score, comorbidity, perioperative morbidity-mortality, and the length of the operation. Results Age (p < 0.001), ASA score (p < 0.001), stage in case of malignancy (p = 0.002), and comorbidities (p < 0.001) were significant risk factors. The ratio of patients without any comorbidities to those with one or more comorbidities was 2.63 (95% CI 1.12–6.20). Among the malignant patients, the ratio of early-stage patients to advanced-stage patients in the group with reversal of Hartmann's colostomy was 2.82 (95% CI 1.30–6.10). In addition, the ratio of older patients to younger patients in group 2 was 0.95 (95% CI 0.92–0.98). A univariate analysis revealed that younger patients, those with lower ASA scores, those without comorbidities, and those with early-stage malignancy had a greater chance of closure of the stoma. Conclusion Although Hartmann's procedure is performed in emergency surgery, the nonreversal of the colostomy is a problem in itself. It should be kept in mind that patients who have high risks are likely to have a permanent stoma.
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Is length of the rectal stump predictive for postoperative outcome in Hartmann's reversal surgery? A multicenter experience of 105 consecutive cases. Int J Colorectal Dis 2022; 37:617-622. [PMID: 35091774 DOI: 10.1007/s00384-021-04090-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Although Hartmann's procedure is commonly performed, subsequent reversal is less frequent. The most common reasons for reversal surgery are advanced age, comorbidities, and perceived surgical difficulties. The main objective of this study was to investigate if the length of the rectal stump influences the outcome of Hartmann's reversal surgery. METHOD We conducted a retrospective case study analyzing data from 105 patients who underwent Hartmann's reversal procedure between 2007 and 2019 in two centers. We evaluated patient demographics, length of rectal stump, intraoperative surgical details, short-term and long-term outcomes. RESULTS From 2007 to 2019, 105 patients underwent Hartmann's reversal surgery. Short-term morbidity rate was 58% (61 patients), including 16% (17 patients) with severe postoperative complication (Clavien-Dindo ≥ 3). Anastomotic leakage rate was 2.9% (3 patients). Long-term complications were present in 41% (43 patients) of which abdominal wall defect was the most frequent complication. The mean length of the rectal stump was 15 cm. In almost 1 out of 5 patients (17%) the rectal stump was shorter than 10 cm. The three anastomotic leakages appeared in the long rectal stump group (3.6% vs. 0%, p = 0.273). The complication rate for patients with a short rectal stump was similar to those with a longer rectal stump (50% vs. 63%, p = 0.275). Smoking, high ASA score, obesity, and advanced age did not influence the outcomes of the reversal procedure either. CONCLUSION Length of the rectal stump is not a predictive factor for postoperative complications after Hartmann's reversal surgery.
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Sato A, Imaizumi K, Kasajima H, Obuchi K, Sato K, Yamana D, Tsuruga Y, Umehara M, Kurushima M, Nakanishi K. Comparison of outcomes between laparoscopic and open Hartmann's reversal: A single-center retrospective study in Japan. Asian J Endosc Surg 2022; 15:137-146. [PMID: 34463037 DOI: 10.1111/ases.12982] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/02/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Laparoscopic Hartmann's reversal (LHR) has recently been reported to be safer and more feasible than open Hartmann's reversal (OHR); however, there is limited data on the outcomes of LHR compared with those of OHR from Asian countries. Therefore, we aimed to clarify the postoperative outcomes of LHR compared with OHR, and additionally compare the patient outcomes post-LHR according to the previous Hartmann's procedure (HP) approach. METHODS Patients who underwent OHR and LHR between January 2006 and September 2020 in a single center in Japan, were retrospectively evaluated. Patient characteristics and perioperative data were collected from the medical and surgical records and assessed. RESULTS Overall, 15 and 19 patients underwent OHR and LHR, respectively, between January 2006 and September 2020. LHR was associated with less blood loss (median: 15 mL vs 185 mL; P < .001) and shorter hospital stays (9 days vs 14 days; P = .023) than OHR. There was no significant difference in postoperative complications between LHR and OHR (26.3% vs 40.0%, P = .475). However, two severe anastomotic complications in LHR were observed in patients with the stump below the peritoneal reflection. No significant difference in outcomes was observed between LHR patients who underwent open and laparoscopic HP. CONCLUSION LHR resulted in positive outcomes regarding estimated blood loss and postoperative hospitalization, compared with OHR. Although the postoperative complications between LHR and OHR were not significant, patients with the stump below the peritoneal reflection may be at a high risk of anastomotic complications.
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Affiliation(s)
- Aya Sato
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Japan
| | - Ken Imaizumi
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Japan
| | - Hiroyuki Kasajima
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Japan
| | - Keisuke Obuchi
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Japan
| | - Kentaro Sato
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Japan
| | - Daisuke Yamana
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Japan
| | - Yosuke Tsuruga
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Japan
| | - Minoru Umehara
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Japan
| | - Michihiro Kurushima
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Japan
| | - Kazuaki Nakanishi
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Japan
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Cho HJ, Kim WR, Kim JW. A comparative study between open versus laparoscopic Hartmann reversal: A single-center experience and analysis. Medicine (Baltimore) 2021; 100:e27976. [PMID: 34964789 PMCID: PMC8615443 DOI: 10.1097/md.0000000000027976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/10/2021] [Indexed: 01/05/2023] Open
Abstract
As one of the most challenging procedures in colorectal surgery, Hartmann reversal (HR) carries a burden of morbidity and mortality. We report our experience and compare open and laparoscopic HR.Between December 2012 and January 2020, 30 patients who underwent Hartmann reversal were reviewed. All patients either received laparoscopic or open reversal.Of the 87 patients who underwent Hartmann operation (HO), 30 patients received HR (Laparoscopic Hartmann Reversal, [LHR], n = 20; Open Hartmann Reversal, Open Hartmann Reversal [OHR], n = 10). There were 15 males and 15 female patients. The mean operation time was 223.8 minutes (range 115-350 minutes) with mean blood loss of 252.5 mL (range 0-700 mL). There was no conversion from LHR to OHR, and there was no ileostomy formation. Mean time to flatus was 5.0 days (range 2-13 days). There were 15 early postoperative complications and 5 late postoperative complications, but only 1 case of grade 3A. No anastomosis leakage was reported.HR is an operation that can be performed safely in well-selected patients. Minimally invasive techniques, such as LHR, is an attractive option resulting in shorter operation time, less blood loss, less pain, and shorter hospital stay.
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van Loon YT, Clermonts SHEM, Belgers EHJ, Kurihara H, Spinelli A, Joshi HM, Gorissen KJ, Zimmerman DDE. Reversal of left-sided colostomy utilizing single-port laparoscopy a multicenter European audit and overview of the literature. Surg Endosc 2021; 36:3389-3397. [PMID: 34312728 PMCID: PMC9001236 DOI: 10.1007/s00464-021-08657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
Background Stoma reversal surgery can result in considerable morbidity and even mortality. Feasibility of utilizing single-port laparoscopy through the stoma fenestration have been shown before. Aim of the present observational study is to evaluate multicenter experiences of single-port reversal of left-sided colostomy (SPRLC) throughout Europe and to provide an overview of available literature on this topic. Methods All patients undergoing SPRLC in four different teaching hospitals throughout Europe are included. Primary outcome was 30-day postoperative complication rate. Secondary outcomes were postoperative length of stay (LOS), single-port success rate and conversion rates. Appraisal of the available literature in PubMed was performed. Results Of 156 SPRLC procedures, 98.7% of them were technically successful and 71.8% were without postoperative complications. No postoperative mortality was encountered. Superficial site infection occurred in 14.7%, anastomotic leakage in 3.9% and major complications in 8.3%. Median LOS was 4.0 days (1–69), single-port success rate was 64.7%, 12.8% and 21.2% (33/154) were converted to an open and multiport laparoscopic procedure, respectively. Literature shows equally favorable results in 131 patients divided over 5 cohorts with morbidity ranging from 0 to 30.4% and mortality from 0 to 2.2% and median LOS of 4–8 days. Conclusion This study confirms the safety, feasibility and favorable results of the use of single-port approach in the reversal of left-sided colostomy in different centers in Europe with laparoscopic experienced colorectal surgeons. The available literature on this topic support and show equally favorable results using single-port laparoscopy for left-sided colostomy reversal surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08657-x.
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Affiliation(s)
- Y T van Loon
- Department of Surgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022GC, Tilburg, The Netherlands.
| | - S H E M Clermonts
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Zuyderland Hospital, Heerlen and Sittard, The Netherlands
| | - E H J Belgers
- Department of Colorectal Surgery, Humanitas University, Milan, Italy
| | - H Kurihara
- Department of Emergency Surgery and Trauma Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - A Spinelli
- Department of Colon and Rectal Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, Milan, Italy
| | - H M Joshi
- Department of Colorectal Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K J Gorissen
- Department of Emergency and Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D D E Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022GC, Tilburg, The Netherlands
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Alves Junior AJT, Pereira JA, Ávila MGD, Domingues FA, Sato DT, Martinez CAR. Tissue content of metalloproteinase-9 and collagen in the colon with and without fecal stream after intervention with infliximab in rats subjected to Hartmann's surgery. Acta Cir Bras 2021; 36:e360401. [PMID: 34008743 PMCID: PMC8128352 DOI: 10.1590/acb360401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/15/2021] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Quantify the tissue content of metalloproteinase-9 (MMP-9) and collagen in colic mucosa with and without intestinal transit after infliximab administration in rats subjected to Hartmann's surgery. METHODS Twenty-two rats underwent colon diversion by Hartmann's surgery. Animals were maintained with intestinal bypass for 12 weeks to induce development of diversion colitis (DC). Afterwards, animals were divided into three groups: first group received subcutaneous application of saline solution (SS) 0.9%, while the remaining two groups received infliximab subcutaneously at doses of 5 or 10 mg·kg-1·week-1 for five consecutive weeks. After the intervention, animals were sacrificed, removing the segments with and without intestinal transit. Diversion colitis was diagnosed by histological study, and its intensity was determined by a validated inflammatory scale. Tissue expression of MMP-9 was assessed byimmunohistochemistry, while total collagen was assessed by histochemistry. Tissue content of both was measuredby computerized morphometry. RESULTS Colon segments without intestinal transit had a higher degree of inflammation, which improved in animals treated with infliximab. Collagen content was always lower in those without intestinal transit. There was an increase in the collagen content in the colon without transit in animals treated with infliximab, primarily at a dose of 10 mg·kg-1·week-1. There was an increase in the content of MMP-9 in the colon without fecal transit, and a reduction was observed in animals treated with infliximab, regardless of the dose used. CONCLUSIONS Application of infliximab reduces inflammation, increases the total collagen content and decreases the content of MMP-9 in the colon without intestinal transit.
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Laparoscopic Versus Open Hartmann Reversal: A Case-Control Study. Surg Res Pract 2021; 2021:4547537. [PMID: 33553574 PMCID: PMC7847322 DOI: 10.1155/2021/4547537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/07/2021] [Accepted: 01/16/2021] [Indexed: 12/13/2022] Open
Abstract
Background Laparoscopic reversal of Hartmann's procedure (LHR) offers reduced morbidity compared with open Hartmann's reversal (OHR). The aim of this study is to compare the outcome of laparoscopic versus open Hartmann reversal. Materials and Methods Thirty-four patients who underwent Hartmann reversal between January 2017 and July 2019 were evaluated. Patients underwent either LHR (n = 17) or OHR (n = 17). Variables such as numbers of patients, patient's age, sex, body mass index (BMI), comorbidities, ASA (American Society of Anesthesiology) score, indication for previous open sigmoid resection, mean operation time, rate of conversion to open surgery, length of hospital stay, mortality, and morbidity were retrospectively evaluated. Results The two groups of patients were homogeneous for gender, age, body mass index, cause of primary surgery, time to reversal, and comorbidities. In 97% of the cases, HP was done by open surgery. Our data revealed no difference in mean operation time (LHR: 180.5 ± 35.1 vs. OHR: 225.2 ± 48.4) and morbidity rate, although, in OHR group, there were more severe complications. Less intraoperative blood loss (LHR: 100 ± 40 mL vs. OHR: 450 ± 125 mL; p value <0.001), shorter time to flatus (LHR: 2.4 days vs. OHR: 3.6 days; p value <0.021), and shorter hospitalization (LHR: 4.4 vs. OHR: 11.2 days; p value <0.001) were observed in the LHR group. Mortality rate was null in both groups. Discussion. LHR is feasible and safe even for patients who received a primary open Hartmann's procedure. We suggest careful patient's selection allowing LHR procedures to highly skilled laparoscopy surgeons.
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Farkas N, Conroy M, Harris H, Kenny R, Baig MK. Hartmann's at 100: Relevant or redundant? Curr Probl Surg 2020; 58:100951. [PMID: 34392941 DOI: 10.1016/j.cpsurg.2020.100951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/15/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Nicholas Farkas
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom.
| | - Michael Conroy
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom
| | - Holly Harris
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom
| | - Ross Kenny
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom
| | - Mirza Khurrum Baig
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom
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Joo Y, Lee Y, Yoo T, Kim J, Park I, Gwak G, Cho H, Yang K, Kim K, Bae BN. Prognostic Factors and Management for Left Colonic Perforation: Can Hartmann's Procedure Be Preventable? Ann Coloproctol 2020; 36:178-185. [PMID: 32674547 PMCID: PMC7392568 DOI: 10.3393/ac.2019.11.14.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To identify factors significantly associated with the mortality of patients with left colonic perforation, and to compare the outcome of Hartmann's procedure (HP) and primary repair (PR) or primary anastomosis (PA) in patients with left colonic perforation without factors associated with mortality. METHODS This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U-tests were used to analyze the data. RESULTS Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Prognostic factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute kidney injury, hemodynamic instability, and the existence of feculent ascites. Leukopenia and longer operative time were independent risk factors for mortality. Seventy-nine patients did not have leukopenia and 30 of these patients who underwent PR without diversion were excluded from the subanalysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no advantage in reducing hospital mortality (P=0.458) and morbidity. CONCLUSION Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve the hospital mortality of the patients without leukopenia. For such patients, PR or PA may be suggested as an alternative option for left colonic perforation.
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Affiliation(s)
- Yilseok Joo
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Yujin Lee
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Taeyoung Yoo
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jungbin Kim
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Inseok Park
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Geumhee Gwak
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Hyunjin Cho
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Keunho Yang
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Kiwhan Kim
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Byung-Noe Bae
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
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Christou N, Rivaille T, Maulat C, Taibi A, Fredon F, Bouvier S, Fabre A, Derbal S, Durand-Fontanier S, Valleix D, Robert-Yap J, Muscari F, Mathonnet M. Identification of risk factors for morbidity and mortality after Hartmann's reversal surgery - a retrospective study from two French centers. Sci Rep 2020; 10:3643. [PMID: 32107426 PMCID: PMC7046632 DOI: 10.1038/s41598-020-60481-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/27/2020] [Indexed: 11/25/2022] Open
Abstract
Hartmann’s reversal procedures are often fraught with complications or failure to recover. This being a fact, it is often difficult to select patients with the optimal indications for a reversal. The post-recovery morbidity and mortality rates in the literature are heterogeneous between 0.8 and 44%. The identification of predictive risk factors of failure of such interventions would therefore be very useful to help the practitioner in his approach. Given these elements, it was important to us to analyze the practice of two French university hospitals in order to highlight such risk factors and to allow surgeons to select the best therapeutic strategy. We performed a bicentric observational retrospective study between 2010 and 2015 that studied the characteristics of patients who had undergone Hartmann surgery and were subsequently reestablished. The aim of the study was to identify factors influencing morbidity and postoperative mortality of Hartmann’s reversal. Primary outcome was complications within the first 90 postoperative days. 240 patients were studied of which 60.4% were men. The mean age was 69.48 years. The median time to reversal was 8 months. 79.17% of patients were operated as emergency cases where the indication was a diverticular complication (39.17%). Seventy patients (29.2%) underwent a reversal and approximately 43% of these had complications within the first 90 postoperative days. The mean age of these seventy patients was 61.3 years old and 65.7% were males. None of them benefited from a reversal in the first three months. We identified some risk factors for morbidity such as pre-operative low albuminemia (p = 0.005) and moderate renal impairment (p = 0.019). However, chronic corticosteroid use (p = 0.004), moderate renal insufficiency (p = 0.014) and coronary artery disease (p = 0.014) seem to favour the development of anastomotic fistula, which is itself, a risk factor for mortality (p = 0.007). Our study highlights an important rate of complications including significant anastomotic fistula after Hartmann’s reversal. Precarious nutritional status and cardiovascular comorbidities should clearly lead us to reconsider the surgical indication for continuity restoration.
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Affiliation(s)
- Niki Christou
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex, 87042, France. .,Department of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Rue Gabrielle Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Thibaud Rivaille
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex, 87042, France
| | - Charlotte Maulat
- Chirurgie digestive et transplantation d'organes (département), Pôle digestif, Hôpital Rangueil, 1, avenue du Professeur Jean Poulhès - TSA 50032, 31059, Toulouse, cedex 9, France
| | - Abdelkader Taibi
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex, 87042, France
| | - Fabien Fredon
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex, 87042, France
| | - Stephane Bouvier
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex, 87042, France
| | - Anne Fabre
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex, 87042, France
| | - Sophiane Derbal
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex, 87042, France
| | - Sylvaine Durand-Fontanier
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex, 87042, France
| | - Denis Valleix
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex, 87042, France
| | - Joan Robert-Yap
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Rue Gabrielle Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Fabrice Muscari
- Chirurgie digestive et transplantation d'organes (département), Pôle digestif, Hôpital Rangueil, 1, avenue du Professeur Jean Poulhès - TSA 50032, 31059, Toulouse, cedex 9, France
| | - Muriel Mathonnet
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex, 87042, France
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Caille C, Collard M, Moszkowicz D, Prost À la Denise J, Maggiori L, Panis Y. Reversal of Hartmann's procedure in patients following failed colorectal or coloanal anastomosis: an analysis of 45 consecutive cases. Colorectal Dis 2020; 22:203-211. [PMID: 31536670 DOI: 10.1111/codi.14854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/15/2019] [Indexed: 02/08/2023]
Abstract
AIM This study aimed to assess outcomes of Hartmann's reversal (HR) after failure of previous colorectal anastomosis (CRA) or coloanal anastomosis (CAA). METHODS All patients planned for HR from 1997 to 2018 following the failure of previous CRA or CAA were included. RESULTS From 1997 to 2018, 45 HRs were planned following failed CRA or CAA performed for rectal cancer (n = 19, 42%), diverticulitis (n = 16, 36%), colon cancer (n = 4, 9%), inflammatory bowel disease (n = 2, 4%) or other aetiologies (n = 4, 9%). In two (4%) patients, HR could not be performed. HR was performed in 43/45 (96%) patients with stapled CRA (n = 24, 53%), delayed handsewn CAA with colonic pull-through (n = 11, 24%), standard handsewn CAA (n = 6, 14%) or stapled ileal pouch-anal anastomosis (n = 2, 4%). One (2%) patient died postoperatively. Overall postoperative morbidity rate was 44%, including 27% of patients with severe postoperative complication (Clavien-Dindo ≥ 3). After a mean follow-up of 38 ± 30 months (range 1-109), 35/45 (78%) patients presented without stoma. Multivariate analysis identified a remnant rectal stump < 7.5 cm in length as the only independent risk factor for long-term persistent stoma. Among stoma-free patients, low anterior resection syndrome (LARS) score was ≤ 20 (normal) in 43%, between 21 and 29 (minor LARS) in 33% and ≥ 30 (major LARS) in 24% of the patients. CONCLUSION HR can be recommended in patients following a failed CRA or CAA. It permits 78% of patients to be free of stoma. A short length of the remnant rectal stump is the only predictive factor of persistent stoma in these patients.
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Affiliation(s)
- C Caille
- Department of Colorectal Surgery, Assistance Publique - Hôpitaux de Paris (AP-HP), Beaujon Hospital, University Denis Diderot (Paris VII), Clichy, France
| | - M Collard
- Department of Colorectal Surgery, Assistance Publique - Hôpitaux de Paris (AP-HP), Beaujon Hospital, University Denis Diderot (Paris VII), Clichy, France
| | - D Moszkowicz
- Department of Colorectal Surgery, Assistance Publique - Hôpitaux de Paris (AP-HP), Beaujon Hospital, University Denis Diderot (Paris VII), Clichy, France
| | - J Prost À la Denise
- Department of Colorectal Surgery, Assistance Publique - Hôpitaux de Paris (AP-HP), Beaujon Hospital, University Denis Diderot (Paris VII), Clichy, France
| | - L Maggiori
- Department of Colorectal Surgery, Assistance Publique - Hôpitaux de Paris (AP-HP), Beaujon Hospital, University Denis Diderot (Paris VII), Clichy, France
| | - Y Panis
- Department of Colorectal Surgery, Assistance Publique - Hôpitaux de Paris (AP-HP), Beaujon Hospital, University Denis Diderot (Paris VII), Clichy, France
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van Loon YT, Clermonts SHEM, Wasowicz DK, Zimmerman DDE. Reversal of left-sided colostomy utilizing single-port laparoscopy: single-center consolidation of a new technique. Surg Endosc 2019; 34:332-338. [DOI: 10.1007/s00464-019-06771-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/18/2019] [Indexed: 02/04/2023]
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Moro-Valdezate D, Royo-Aznar A, Martín-Arévalo J, Pla-Martí V, García-Botello S, León-Espinoza C, Fernández-Moreno MC, Espín-Basany E, Espí-Macías A. Outcomes of Hartmann's procedure and subsequent intestinal restoration. Which patients are most likely to undergo reversal? Am J Surg 2019; 218:918-927. [PMID: 30853093 DOI: 10.1016/j.amjsurg.2019.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/06/2019] [Accepted: 02/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aim of the study was to describe characteristics and outcomes of Hartmann's procedure (HP) and subsequent intestinal restoration. METHODS Retrospective study including all patients who underwent HP over a period of 16 consecutive years. We propose a classification and regression tree for a more accurate view of the relationship between the variables related to intestinal restoration and their weighting in the decision to reverse HP. RESULTS 533 patients were included. Overall morbidity rate of HP was 53.5% and mortality 21.0%. Overall morbidity of the intestinal continuity reconstruction was 47.3% and mortality 0.9%. Patients with a benign disease, aged under 69 years and with low comorbidity, had an 84.4% probability of undergoing intestinal reconstruction. CONCLUSIONS HP is associated with high morbidity and mortality. Restoration of intestinal continuity involves minor, but frequent, morbidity and a low mortality rate. Age and comorbidities can decrease, and even override, the decision to reverse HP.
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Affiliation(s)
- D Moro-Valdezate
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain.
| | - A Royo-Aznar
- Department of Surgery, Universtitat Autònoma de Barcelona, Barcelona, Spain
| | - J Martín-Arévalo
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - V Pla-Martí
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - S García-Botello
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - C León-Espinoza
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - M C Fernández-Moreno
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - E Espín-Basany
- Department of Surgery, Universtitat Autònoma de Barcelona, Barcelona, Spain
| | - A Espí-Macías
- Department of Surgery, University of Valencia, Valencia, Spain
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16
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Park W, Park WC, Kim KY, Lee SY. Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal. Ann Coloproctol 2018; 34:306-311. [PMID: 30572420 PMCID: PMC6347334 DOI: 10.3393/ac.2018.09.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/07/2018] [Indexed: 02/01/2023] Open
Abstract
Purpose Hartmann operation is widely recognized as a useful procedure, especially in emergencies involving the rectosigmoid colon. One of the surgeon’s foremost concerns after Hartmann operation is future colostomy reversal, as colostomy reversal after a Hartmann procedure is associated with relatively high morbidity and mortality. Laparoscopic surgical techniques continue to prove useful for an ever-increasing variety of indications. We analyzed the outcomes of laparoscopic Hartmann colostomy reversals at our center. Methods We retrospectively analyzed the hospital records of 170 patients who had undergone Hartmann operation between January 2010 and June 2017 at Wonkwang University Hospital. Among 68 Hartmann colostomy reversals, we evaluated and compared the outcomes of 3 groups of patients: 29 patients in the open colostomy reversal group (OG) who had undergone laparotomies for Hartmann reversals, 19 patients in the conversion group (CG) whose laparoscopic procedures had required conversion to a laparotomy, and 20 patients in the laparoscopy group (LG). Results The overall reversal rate for Hartmann colostomies was 40.5% during this time period. The duration of hospital stay was significantly shorter among LG patients (10.15 ± 2.94 days) than among OG patients (16 ± 9.5 days). The overall complication rate among OG patients was higher than that among LG patients (adjusted odds ratio, 8.78; P = 0.01). The most common complication was postoperative ileus (19.1%). Conclusion If no contraindications to laparoscopy exist, surgeons should favor a laparoscopic reversal of Hartmann operation over an open reversal.
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Affiliation(s)
- Won Park
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Won Cheol Park
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Keun Young Kim
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Seok Youn Lee
- Department of Surgery, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
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Fonseca AZ, Uramoto E, Santos-Rosa OM, Santin S, Ribeiro M. COLOSTOMY CLOSURE: RISK FACTORS FOR COMPLICATIONS. ACTA ACUST UNITED AC 2018; 30:231-234. [PMID: 29340543 PMCID: PMC5793137 DOI: 10.1590/0102-6720201700040001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/22/2017] [Indexed: 12/15/2022]
Abstract
Background : The restoration of intestinal continuity is an elective procedure that is not free of complications; on the contrary, many studies have proven a high level of morbidity and mortality. It is multifactorial, and has factors inherent to the patients and to the surgical technique. Aim : To identify epidemiological features of patients that underwent ostomy closure analyzing the information about the surgical procedure and its arising complications. Method : It was realized a retrospective analysis of medical records of patients who underwent ostomy closure over a period of seven years (2009-2015). Results : A total of 39 patients were included, 53.8% male and 46.2% female, with mean age of 52.4 years. Hartmann´s procedure and ileostomy were the mainly reasons for restoration of intestinal continuity, representing together 87%. Termino-terminal anastomosis was performed in 71.8% of cases, by using mainly the manual technique. 25.6% developed complications, highlighting anastomotic leakage; there were three deaths (7.6%). The surgical time, the necessity of ICU and blood transfusion significantly related to post-operative complications. Conclusion : It was found that the majority of the patients were male, with an average age of 52 years. It was observed that the surgical time, the necessity of blood transfusion and ICU were factors significantly associated with complications.
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Affiliation(s)
| | - Edson Uramoto
- Department of Surgery, University of Santo Amaro, São Paulo, SP, Brazil
| | | | - Stephanie Santin
- Department of Surgery, University of Santo Amaro, São Paulo, SP, Brazil
| | - Marcelo Ribeiro
- Department of Surgery, University of Santo Amaro, São Paulo, SP, Brazil
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18
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Cengiz TB, Steele SR, Delaney CP, Kessler H. Laparoscopic Hartmann's reversal surgery in a complex abdomen - a video vignette. Colorectal Dis 2018; 20:648. [PMID: 29679521 DOI: 10.1111/codi.14232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 02/08/2023]
Affiliation(s)
- T B Cengiz
- Department of Colorectal Surgery-A30, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - S R Steele
- Department of Colorectal Surgery-A30, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - C P Delaney
- Department of Colorectal Surgery-A30, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - H Kessler
- Department of Colorectal Surgery-A30, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Chereau N, Lefevre JH, Chafai N, Hor T, Debove C, Tiret E, Parc Y. Hartmann's reversal after colonic perforation or anastomosis leakage, is it the same procedure? A retrospective study of 150 patients. Langenbecks Arch Surg 2018; 403:435-441. [PMID: 29671066 DOI: 10.1007/s00423-018-1667-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/19/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The high morbidity rates reported might influence surgeons' decisions of whether to perform Hartmann's reversal (HR). Our aim was to report the results of HR after "primary" Hartmann's procedure (HP) or in redo surgery for failed anastomosis. METHODS All patients operated between 2007 and 2015 were included. Data and postoperative course were obtained from a review of medical records and databases. RESULTS One hundred fifty patients (age 60, range (20-91) years, 62% male) were included. Eighty-six patients (57%) were ASA ≥ 2. HP was mostly performed for diverticulitis (29.3%) and anastomotic leakage (24%). HR was possible in 145(97%) patients including six with previous failed attempt. Overall morbidity was 22.7% including 11.7% severe complications (Dindo 3-4). Operative blood loss and Charlson comorbidity index were the only significant risk factor for postoperative pelvic complications (p = 0.03; p = 0.0002, respectively). CONCLUSIONS In a colorectal tertiary center, HR was feasible in 97% with a low morbidity and a 3.4% anastomotic leakage rate.
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Affiliation(s)
- Nathalie Chereau
- Department of Digestive and General Surgery, Hôpital Saint Antoine, Sorbonne Université, Paris VI, France
| | - Jeremie H Lefevre
- Department of Digestive and General Surgery, Hôpital Saint Antoine, Sorbonne Université, Paris VI, France.
| | - Najim Chafai
- Department of Digestive and General Surgery, Hôpital Saint Antoine, Sorbonne Université, Paris VI, France
| | - Thevy Hor
- Department of Digestive and General Surgery, Hôpital Saint Antoine, Sorbonne Université, Paris VI, France
| | - Clotilde Debove
- Department of Digestive and General Surgery, Hôpital Saint Antoine, Sorbonne Université, Paris VI, France
| | - Emmanuel Tiret
- Department of Digestive and General Surgery, Hôpital Saint Antoine, Sorbonne Université, Paris VI, France
| | - Yann Parc
- Department of Digestive and General Surgery, Hôpital Saint Antoine, Sorbonne Université, Paris VI, France
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20
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Reversal of Hartmann’s procedure: still a complicated operation. Tech Coloproctol 2017; 22:81-87. [DOI: 10.1007/s10151-017-1735-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/19/2017] [Indexed: 12/11/2022]
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21
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Cassini D, Miccini M, Manoochehri F, Gregori M, Baldazzi G. Emergency Hartmann's Procedure and Its Reversal: A Totally Laparoscopic 2-Step Surgery for the Treatment of Hinchey III and IV Diverticulitis. Surg Innov 2017; 24:557-565. [PMID: 28748737 DOI: 10.1177/1553350617722226] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hartmann's procedure (HP) followed by reversal restoration is the first choice for treatment of diffuse diverticular peritonitis. There is no unanimous consensus regarding the use of laparoscopy to treat the same condition. METHODS Data from 60 patients with diverticular diffuse peritonitis who underwent urgent HP followed by laparoscopic reversal were retrospectively analyzed. Patients were divided into 2 groups according to the open or laparoscopic HP (OHP, 24 patients; LHP, 36 patients). Outcomes were measured in terms of functional recovery, morbidity, mortality, and length of hospital stay. RESULTS HPs showed no differences among the groups in terms of operative time, blood loss, and length of intensive care unit stay. Overall morbidity was significantly lower in LHP than in OHP, corresponding to 33.3% and 66.7% respectively ( P = .018). The incidence of both surgical and medical complications was higher in OHP than in LHP (41.7% vs 22.2% [ P = .044] and 45.8% vs 24.3% [ P = .023], respectively). Mortality was 16.6% for each group. LHP showed a faster return to bowel movements and a shorter hospital stay than OHP. The secondary intestinal reversal was possible in 92% of cases, successfully completed laparoscopically in 91.3%. No patients of LHP group required a conversion to open intestinal reversal. CONCLUSION LHP for treatment of diverticular diffuse peritonitis showed significantly lower morbidity, faster recovery, shorter hospital stay, and higher rates of successful laparoscopic reversal when compared with OHP.
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22
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Laparoscopically Assisted Reversal of Hartmann's Procedure for Perforated Diverticulitis. Int Surg 2017. [DOI: 10.9738/intsurg-d-16-00125.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to retrospectively review the clinical outcomes of laparoscopically assisted and open surgical reversal of Hartmann's procedure (HR). We reviewed all patients undergoing laparoscopic or open HR at Tri-Service General Hospital, Taipei, Taiwan, between January 2002 and January 2010. A total of 34 perforated diverticulitis patients initially treated by exploratory laparotomy with Hartmann's procedure were enrolled and divided into 2 groups: laparoscopic and open HR. Data relative to patient age at the time of HR, sex, body mass index, operative time, longest incision length, estimated blood loss, intraoperative complications, postoperative complications, time to bowel function return, duration of hospitalization, and length of follow-up were reviewed. The median colostomy closure period was significantly higher in the laparoscopic group than in the open group (P = 0.011). The median longest incision length, estimated blood loss, time to first oral intake, and hospital stay were significantly lower in the laparoscopic group compared with the open group. Laparoscopic HR may be a technically safe, feasible approach that provides better cosmesis, less blood loss, and faster recovery compared with open HR.
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Abstract
Temporary stomas are frequently used in the management of diverticulitis, colorectal cancer, and inflammatory bowel disease. These temporary stomas are used to try to mitigate septic complications from anastomotic leaks and to avoid the need for reoperation. Once acute medical conditions have improved and after the anastomosis has been proven to be healed, stomas can be reversed. Contrast enemas, digital rectal examination, and endoscopic evaluation are used to evaluate the anastomosis prior to reversal. Stoma reversal is associated with complications including anastomotic leak, postoperative ileus, bowel obstruction, enterocutaneous fistula, and, most commonly, surgical site infection. Furthermore, many stomas, which were intended to be temporary, may not be reversed due to postoperative complications, adjuvant therapy, or prohibitive comorbidities.
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Affiliation(s)
- Karen L Sherman
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
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Lucchetta A, De Manzini N. Laparoscopic reversal of Hartmann procedure: is it safe and feasible? Updates Surg 2016; 68:105-10. [DOI: 10.1007/s13304-016-0363-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/23/2016] [Indexed: 01/19/2023]
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Daher R, Barouki E, Chouillard E. Laparoscopic treatment of complicated colonic diverticular disease: A review. World J Gastrointest Surg 2016; 8:134-142. [PMID: 26981187 PMCID: PMC4770167 DOI: 10.4240/wjgs.v8.i2.134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 10/11/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Up to 10% of acute colonic diverticulitis may necessitate a surgical intervention. Although associated with high morbidity and mortality rates, Hartmann’s procedure (HP) has been considered for many years to be the gold standard for the treatment of generalized peritonitis. To reduce the burden of surgery in these situations and as driven by the accumulated experience in colorectal and minimally-invasive surgery, laparoscopy has been increasingly adopted in the management of abdominal emergencies. Multiple case series and retrospective comparative studies confirmed that with experienced hands, the laparoscopic approach provided better outcomes than the open surgery. This technique applies to all interventions related to complicated diverticular disease, such as HP, sigmoid resection with primary anastomosis (RPA) and reversal of HP. The laparoscopic approach also provided new therapeutic possibilities with the emergence of the laparoscopic lavage drainage (LLD), particularly interesting in the context of purulent peritonitis of diverticular origin. At this stage, however, most of our knowledge in these fields relies on studies of low-level evidence. More than ever, well-built large randomized controlled trials are necessary to answer present interrogations such as the exact place of LLD or the most appropriate sigmoid resection procedure (laparoscopic HP or RPA), as well as to confirm the advantages of laparoscopy in chronic complications of diverticulitis or HP reversal.
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The Reversal of Stoma Following Open Abdomen Management. Indian J Surg 2015; 78:182-6. [PMID: 27358511 DOI: 10.1007/s12262-015-1336-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/26/2015] [Indexed: 01/19/2023] Open
Abstract
Bowel stoma formation is very often required during open abdomen (OA) management; we aim to report our stoma reversal series following OA management retrospectively. A retrospective analysis of 31 patients who underwent the reversal of the stoma created during OA management between January 2008 and September 2014 was performed. Twenty-eight of these 31 patients were included in this study. The stoma-related complications are more common after OA management during waiting time interval for reversal. At this time interval, patients with jejunostomy had more stoma-related complications than patients with ileostomy (p = 0.008) and colostomy. (p = 0.001). Waiting time interval was shorter for reversal of jejunostomy than reversal of ileostomy (p = 0.014) and colostomy (p = 0.001). Operation time for jejunostomy (p = 0.016) and colostomy reversal (p = 0.001) were significantly longer than the ileostomy reversal. There was no difference between early and late reversal of stoma regarding morbidity and mortality. The stoma-related complications are more common following OA management during waiting time interval for stoma reversal. The reversal time is more critical for this kind of patients especially with life-threatening complicated jejunostomy. For loop stoma created during OA management, the reversal may be performed after average 50 days without increasing morbidity and mortality. The reversal of end stoma created during OA management has high morbidity. If it is possible, loop stoma should be preferred during OA management.
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