Riesgos en Reconstitución de Tránsito tras Operación de Hartmann

Reversal of Hartmann’s procedure: A high-risk operation?
Thomas Schmelzer, Gamal Mostafa, James Norton, William Newcomb, William Hope, Amy Lincourt, Kent Kercher, Timothy Kuwada, Keith Gersin and Todd Heniford. Department of Surgery, Carolinas Medical Center, Charlotte, NC.

Background
Patients who undergo Hartmann’s procedure often do not have their colostomy closed based on the perceived risk of the operation. This study evaluated the outcome of reversal of Hartmann’s procedure based on preoperative risk factors.

Methods
We retrospectively reviewed adult patients who underwent reversal of Hartmann’s procedure at our tertiary referral institution. Patient outcomes were compared based on identified risk factors (age >60 years, American Society of Anesthesiologists [ASA] score >2, and >2 preoperative comorbidities).

Results
One-hundred thirteen patients were included. Forty-four patients (39%) had an ASA score of ≥3. The mean hospital duration of stay was 6.8 days. There were 28 (25%) postoperative complications and no mortality. Patients >60 years old had significantly longer LOS compared with the rest of the group (P = .02). There were no differences in outcomes between groups based on ASA score or the presence of multiple preoperative comorbidities. An albumin level of <3.5 was the only significant predictor of postoperative complications (P = .04).

Conclusions
The reversal of Hartmann’s operation appears to be a safe operation with acceptable morbidity rates and can be considered in patients, including those with significant operative risk factors.