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.
Subject(s)
Humans , Colon , Colostomy , Emergencies , Hospital Records , Ileus , Laparoscopy , Laparotomy , Length of Stay , Mortality , Odds Ratio , Retrospective Studies , SurgeonsABSTRACT
Objective To explore the safety and efficacy of loop ileostomy and Hartmann operation in gerontal patients with obstructive carcinoma of sigmoid and high rectum. Methods sixty-two gerontal patients with obstructive carcinoma of sigmoid and high rectum from April 2008 to April 2013 were randomly divided into loop ileostomy group and Hartmann group.The operation time , length of stay and postoperative complications in the two groups were analyzed. Results The time of absolute diet in loop ileostomy group was shorter than that in Hartmann group in Stage I operation (P < 0.05). The time of operation, absolute diet, and length of stay in loop ileostomy group were shorter than that in Hartmann group in Stage II operation (P < 0.05). Conclusion The application of loop iloostomy in gerontal patients with obstructive carcinoma of sigmoid and high rectum was safe and effective.
ABSTRACT
Objective To discuss the technical keypoints of the second-phase diaplasis treatment after Hartmann operation. Methods Twenty-one cases of the second-phase diaplasis operation of Hartmann operation in this hospital from January 2003 to December 2007 were analysed retrospectively. Results In this group, stapler technique was used in 15 cases, anastomotic ring was used in 3 cases, and one-layer suture was used in 3 cases. The time of these operations was between 118 min and 240 min (mean 164 min). Neither stomal leak nor stomal stenosis occurred, acute ileus occurred in 2 cases, and both recovered after the treatments of gastrointestinal decompression, inhibition of secretion digestive juice and reoperation. Acute retension of urine occurred in 1 case after urine catheter removed. The symptoms disappeared after excises of bladder function. These cases were followed up for 3-36 months (mean 20 months). All the patients recovered to normal function of defecation. Conclusion The technical keypoints of the second-phase diaplasis treatment after Hartmann operation are how to find and liberate the end of the distal colon. It will affect the prognosis and the occurrence of complications after this operation.