Hartmann's reversal as a safe procedure for selected patients: analysis of 199 patients at a high-volume center in Sao Paulo.
PURPOSE
We analyzed the morbidity and mortality associated with Hartmann's reversal (HR) and the risk factors for major complications and mortality.


METHODS
The subjects of this retrospective study were patients who underwent HR in a high-volume center. We evaluated complications as categorical variables using univariate analyses.


RESULTS
Between 2003 and 2018, 199 patients underwent HR at our hospital [56.5 years; body mass index (BMI): 26.3 kg/m2; American Society of Anesthesiology score (ASA) 3: 7.5%; 36.2% had hernias]. The mean time to HR was 20.2 months and the mean operation time was 302 min. The anastomosis was stapled in 71.4% and was performed in the low/medium rectum in 21.6%. Midline hernias were repaired with mesh in 80.1%. The mean hospitalization period was 10.1 days. Surgical site infection (SSI) developed in 27.1% of the patients, 94.4% of whom were treated at the bedside. BMI was a risk factor for SSI (27.8 vs. 25.6; p = 0.047). Major complications (Clavien-Dindo III-V) developed in 27 patients (13.5%), including anastomosis dehiscence in 2.5%. ASA, BMI, age, hernia repair, and rectal stump size were not associated with major complications. The mortality rate was 2.5%. An ASA of 3 was associated with high mortality (p = 0.03).


CONCLUSION
Hartmann's reversal remains challenging but can have low complication and mortality rates if performed on selected patients in a reference center. An ASA of 3 was the only predictor of mortality.
['Bitran|Alberto|A|http://orcid.org/0000-0002-3774-5204', 'Rasslan|Roberto|R|http://orcid.org/0000-0003-1540-0050', 'de Oliveira Ferreira|Fabio|F|http://orcid.org/0000-0002-5340-2578', 'Utiyama|Edivaldo Massazo|EM|http://orcid.org/0000-0002-8376-975X', 'Rasslan|Samir|S|http://orcid.org/0000-0002-1800-6780']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D001938:Brazil D003125:Colostomy D005260:Female D006761:Hospitals D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D061646:Operative Time D018579:Patient Selection D011183:Postoperative Complications D012189:Retrospective Studies D012307:Risk Factors D013529:Surgical Wound Dehiscence D013530:Surgical Wound Infection D055815:Young Adult
Morbidity Hartmann’s reversal Ostomy closure Postoperative outcome Stoma