The Role of Hartmann’s Procedure and Options for its Reconstruction at the Present Time

Česká verzia

Authors: M. Huťan; V. Hájovský; M. Huťan ml. ^*; J. Rybár
Authors place of work: IV. chirurgická klinika LF UKo a FNsP Bratislava, Slovenská republika prednosta: doc. MUDr. Martin Huťan, CSc. ; II. chirurgická klinika LF UKo a FNsP Bratislava, Slovenská republika prednosta: doc. MUDr. Ján Škultéty, CSc. ^*
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 5, s. 293-297.
Category: Monothematic special - Original

Summary

Introduction:
Hartmann operation (rectosigmal resection, blind closure of rectum and terminal sigmostomy) is one of the options of treatment of pathology of left colon. Despite great effort to treat such surgical conditions with primary anastomosis, Hartmann’s operation is in selected cases preferred. It requires, though, secondary reconstruction, which might be associated with complications.

Aim of the study:
Analyzing patients after Hartmann’s operations with evaluation of risk, complications, morbidity and mortality.

Material and methods:
Authors analyzed group of 61 patients, which were operated on in years 2004–2008, with Hartmann’s operation performed. They state surgical conditions, Hinchey classification, risk rate according to ASA and MPI, and concommitant diseases.

Results:
Of complications, most frequent were wound infections and pneumonia, nine patients (14.7%) died. In presented time period, nineteen reconstructions after Hartmann’s procedure were performed. Morbidity in this category was high, no death was noted. Authors analyze factors, that influence decision of operation for pathology of left colon and possibilities of reconstruction after Hartmann’s procedure.

Conclusion:
Authors state, that Hartmann’s procedure has still its place in urgent operations. Reconstruction in feasible in high percentage of patients with minimal mortality, difficulty lies with high morbidity.

Key words:
Hartmann’s procedure – Mannheim Peritonitis Index – complications – reconstruction – Hinchey

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