Ballian N, Zarebczan B, Munoz A, Harms B, Heise CP, Foley EF, Kennedy GD.

J Gastrointest Surg. 2009 Dec;13(12):2260-7. doi: 10.1007/s11605-009-0987-3. Epub 2009 Sep 2.

Department of Surgery, University of Wisconsin, G4/701 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-7375, USA.

Abstract

BACKGROUND:

Reversal of Hartmann’s is a common surgical procedure. Routine preoperative evaluation of the distal colonic/rectal remnant (DCRR) with contrast and/or endoscopic studies is frequently performed despite lack of evidence to support this practice. We hypothesize that asymptomatic patients can safely undergo Hartmann’s reversal without preoperative DCRR evaluation.

METHODS:

Adult patients undergoing reversal of Hartmann’s at a single institution were retrospectively identified. Operative characteristics and outcomes in patients with and without preoperative DCRR evaluation were compared.

RESULTS:

Between 1993 and 2008, 203 patients underwent reversal of Hartmann’s at a tertiary referral center. Sixty-eight patients (33%) did not undergo preoperative DCRR evaluation and had comparable demographic characteristics, comorbidities, DCRR length, and perioperative outcomes to 135 patients who underwent preoperative contrast and/or endoscopic studies. After evaluation, 125 (93%) patients had normal findings, seven (5%) patients had abnormal studies that did not impact their management, and three (2%) patients underwent additional procedures.

CONCLUSION:

Hartmann’s reversal without previous DCRR evaluation is acceptable in selected asymptomatic patients, without increased risk of complications.

PMID: 19727977 [PubMed – indexed for MEDLINE]