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Reversal of Hartmann’s procedure following acute diverticulitis: is timing everything?

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Patients who undergo a Hartmann’s procedure may not be offered a reversal due to concerns over the morbidity of the second procedure. The aims of this study were to examine the morbidity post reversal of Hartmann’s procedure.

Methods

Patients who underwent a Hartmann’s procedure for acute diverticulitis (Hinchey 3 or 4) between 1995 and 2006 were studied. Clinical factors including patient comorbidities were analysed to elucidate what preoperative factors were associated with complications following reversal of Hartmann’s procedure.

Results

One hundred and ten patients were included. Median age was 70 years and 56% of the cohort were male (n = 61). The mortality and morbidity rate for the acute presentation was 7.3% (n = 8) and 34% (n = 37) respectively. Seventy six patients (69%) underwent a reversal at a median of 7 months (range 3–22 months) post-Hartmann’s procedure. The complication rate in the reversal group was 25% (n = 18). A history of current smoking (p = 0.004), increasing time to reversal (p = 0.04) and low preoperative albumin (p = 0.003) were all associated with complications following reversal.

Conclusions

Reversal of Hartmann’s procedure can be offered to appropriately selected patients though with a significant (25%) morbidity rate. The identification of potential modifiable factors such as current smoking, prolonged time to reversal and low preoperative albumin may allow optimisation of such patients preoperatively.

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Acknowledgements

The authors would like to thank Dr. J. Saunders, Statistical Consulting Unit University of Limerick, for her invaluable assistance with the statistical analysis.

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Authors and Affiliations

  1. Surgical Professorial Unit, Department of Surgery, Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland

    Fergal J. Fleming & Peter Gillen

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  1. Fergal J. Fleming
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  2. Peter Gillen
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Correspondence to Fergal J. Fleming.

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Fleming, F.J., Gillen, P. Reversal of Hartmann’s procedure following acute diverticulitis: is timing everything?. Int J Colorectal Dis 24, 1219–1225 (2009). https://doi.org/10.1007/s00384-009-0747-6

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  • DOI: https://doi.org/10.1007/s00384-009-0747-6

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