Reversal of Hartmann's procedure in patients following failed colorectal or coloanal anastomosis: an analysis of 45 consecutive cases.
Aged
Anal Canal
/ surgery
Anastomosis, Surgical
/ adverse effects
Colon
/ surgery
Colonic Diseases
/ surgery
Female
Humans
Male
Postoperative Complications
/ epidemiology
Proctocolectomy, Restorative
/ adverse effects
Prospective Studies
Rectal Diseases
/ surgery
Rectum
/ surgery
Reoperation
/ methods
Retrospective Studies
Risk Factors
Surgical Stomas
/ adverse effects
Treatment Failure
Hartmann's reversal
anastomotic leakage
definitive stoma
functional results
redo surgery
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
22
04
2019
accepted:
15
08
2019
pubmed:
20
9
2019
medline:
23
4
2021
entrez:
20
9
2019
Statut:
ppublish
Résumé
This study aimed to assess outcomes of Hartmann's reversal (HR) after failure of previous colorectal anastomosis (CRA) or coloanal anastomosis (CAA). All patients planned for HR from 1997 to 2018 following the failure of previous CRA or CAA were included. 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. 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.
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
203-211Informations de copyright
Colorectal Disease © 2019 The Association of Coloproctology of Great Britain and Ireland.
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