Timing of colostomy reversal following Hartmann's procedure for perforated diverticulitis

N. Horesh, Y. Lessing, Y. Rudnicki, I. Kent, H. Kammar, A. Ben-Yaacov, Y. Dreznik, A. P. Zbar, H. Tulchinsky, S. Avital, E. Mavor, H. Kashtan, Joseph Klausner, M. Gutman, O. Zmora, N. Wasserberg

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: Hartmann's procedure is the surgical treatment of choice for perforated acute diverticulitis. Hartmann's reversal (HR) that is performed at a later stage may be challenging. The optimal timing for HR is still a subject for controversy. The aim of this study is to assess whether the timing of HR affects surgical outcome. Patients and methods: A retrospective-cohort multi-center study was conducted, including all patients who underwent HR for acute diverticulitis from January 2004 to June 2015 in 5 medical centers. Patient data included demographics, surgical data and post-operative outcome. Results: One hundred and twenty-two patients were included in the database. Median time from Hartmann's procedure to reversal was 182.7 days, with the majority of patients (76 patients, 62.2%) operated 60 to 180 days from the Hartmann's procedure. Fifty-seven patients (46.7%) had post-operative complications, most commonly wound infections (27 patients, 22.1%). Receiver operating characteristic (ROC) curve and a propensity score match analysis (P = 0.43) correlating between days to HR from the index procedure showed no specific cut-off point regarding post-operative complications (P = 0.16), Major (Clavien–Dindo score of 3 or more) complications (P = 0.19), Minor (Clavien Dindo 1-2) and no complications (P = 0.14). Median length of stay was 10.9 days (range 3-90) and Pearson correlation failed to demonstrate a correlation between timing of surgical intervention and length of stay (P = 0.4). Conclusion: Hartmann's Reversal is a complex surgical procedure associated with high rates of complications. In our series, timing of surgery did not affect surgical complications rate or severity or the length of hospital stay.

Original languageEnglish
Pages (from-to)395-400
Number of pages6
JournalJournal of visceral surgery
Volume157
Issue number5
DOIs
StatePublished - Oct 2020

Keywords

  • Colorectal Surgery
  • Colostomy
  • Hartmann's Reversal
  • Post-operative complications

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