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- Title
Reversal of Hartmann’s procedure: timelines, preoperative investigations and early outcomes. A single Australian institution’s ten-year experience.
- Authors
Suthakaran, Reshi; Faragher, Ian G.; Yeung, Justin M. C.
- Abstract
Background: Real-world data on outcomes following Hartmann’s reversal is necessary to help optimize the patient experience. We have explored the timing between the index operation and its reversal; what investigations were carried out prior to this, and the associated short-term outcomes. Methods: A retrospective study of all patients who underwent Hartmann’s reversal from 2010 to 2020 within a tertiary referral centre in Melbourne, Australia. One hundred from a total of 406 (25%) who underwent an emergency Hartmann’s procedure had a subsequent reversal. Complete patient data was available for 83 of these patients. Results: The average patient age was 60 years, and the median time for reversal was 14.0 (IQR 10–23) months. Seventy-nine of 83 (95%) reversals had a preoperative endoscopic evaluation of both their rectal stump and a complete colonoscopy. Stoma stenosis (n = 2), patient refusal (n = 1) and emergency reversal (n = 1) were cited reasons for not undergoing preoperative endoscopic evaluation. A third (n = 28, 34%) had a computed tomography prior to reversal; the majority was due to their underlying cancer surveillance (n = 21, 75%). Reversal was associated with a morbidity rate of 47% (n = 39). Surgical site infections (SSIs) (n = 21, 25%) were the most common type of complications encountered, with the majority being superficial (n = 15, 71%). SSIs were associated with steroid use (5/21 versus 4/62, p = 0.03) and greater hospital length of stay (6 versus 10 days, p = 0.03). Conclusion: Only a quarter of emergency Hartmann’s procedures within our institution were reversed. A significant proportion developed postoperative complications. Surgical site infection was the most common morbidity
- Subjects
MELBOURNE (Vic.); SURGICAL site infections; ILEOSTOMY; LENGTH of stay in hospitals; TIME reversal; PATIENTS' attitudes; COMPUTED tomography
- Publication
ANZ Journal of Surgery, 2023, Vol 93, Issue 1/2, p214
- ISSN
1445-1433
- Publication type
Article
- DOI
10.1111/ans.18045