Hartmann’s Reversal is More Complex Than Elective Left Colectomy
Background Hartmann’s reversal (HR) is associated with significant technical complexity and morbidity. The decision to perform HR is difficult and up to 50% of patients with colostomies do not undergo a reversal. To better guide surgeons and patients with this decision, we sought to assess the surgi...
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| Veröffentlicht in: | The American surgeon 2023-02, Vol.89 (2), p.224-229 |
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| creator | Nasseri, Yosef Liu, Andy Kasheri, Eli Oka, Kimberly Cohen, Jason Ellenhorn, Joshua Bergamaschi, Roberto Barnajian, Moshe |
| description | Background
Hartmann’s reversal (HR) is associated with significant technical complexity and morbidity. The decision to perform HR is difficult and up to 50% of patients with colostomies do not undergo a reversal. To better guide surgeons and patients with this decision, we sought to assess the surgical risks and outcomes of HR as compared to elective left colectomy (LC).
Methods
We conducted a retrospective analysis of a prospective database at a tertiary medical center. Patients undergoing elective Hartmann’s reversal and left colectomy between January 2014 and November 2021 were identified. We compared preoperative variables, intraoperative events, and short-term postoperative outcomes.
Results
135 patients were identified: 30 HR and 105 LC. There were no significant differences in demographics or preoperative comorbidities between HR and LC. There were more open and fewer robotic cases in HR (23.3% vs 2.9%, P < .0001; 46.6% vs 76.0%, P < .01). Total operative time was significantly longer in HR than LC (261.8 vs 211.7 minutes, P = .02). There was a significantly higher percentage of intraoperative complications in HR (13.3% vs 1.9%, P < .01). There was a significantly higher rate of minor postoperative complications in HR than LC (46.7% vs 26.7%, P = .04), but not major (6.7% vs 5.8%, P = .85). Time to first flatus/bowel movement was significantly longer in HR than LC (3.6 vs 2.5 days, P < .001).
Conclusion
Hartmann’s reversal is a more technically challenging operation than elective left colectomy and is associated with significantly higher rates of intraoperative and minor postoperative complications. Future studies should focus on mitigating these risk factors to optimize patient outcomes. |
| doi_str_mv | 10.1177/00031348221135777 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2731428863</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_00031348221135777</sage_id><sourcerecordid>2765295009</sourcerecordid><originalsourceid>FETCH-LOGICAL-c320t-bdf698ff697f765926f8a14a75b4e95bbdfd71fc89e5578093c7871be118d7b03</originalsourceid><addsrcrecordid>eNp1kM9Kw0AQxhdRbK0-gBcJePGSurObzW6OWqoVKoLUc9gkE43kT91Nir35Gr6eT-KGVgXFywzD95tvho-QY6BjACnPKaUceKAYA-BCSrlDhiCE8CPF-C4Z9rrfAwNyYO2zG4NQwD4Z8JAzYIwPyeVMm7bSdf3x9m69e1yhsbr0CuvdNga9SVMtS3z1Fk-69qYlpm2xQm-Oeeukfmyq9SHZy3Vp8WjbR-TharqYzPz53fXN5GLup5zR1k-yPIxU7orMZSgiFuZKQ6ClSAKMROL0TEKeqgiFkIpGPJVKQoIAKpMJ5SNytvFdmualQ9vGVWFTLEtdY9PZmEkOAVMq5A49_YU-N52p3XeOCgWLBHX-IwIbKjWNtQbzeGmKSpt1DDTuA47_BOx2TrbOXVJh9r3xlagDxhvA6kf8Ofu_4yesPoFX</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2765295009</pqid></control><display><type>article</type><title>Hartmann’s Reversal is More Complex Than Elective Left Colectomy</title><source>MEDLINE</source><source>SAGE Complete</source><creator>Nasseri, Yosef ; Liu, Andy ; Kasheri, Eli ; Oka, Kimberly ; Cohen, Jason ; Ellenhorn, Joshua ; Bergamaschi, Roberto ; Barnajian, Moshe</creator><creatorcontrib>Nasseri, Yosef ; Liu, Andy ; Kasheri, Eli ; Oka, Kimberly ; Cohen, Jason ; Ellenhorn, Joshua ; Bergamaschi, Roberto ; Barnajian, Moshe</creatorcontrib><description>Background
Hartmann’s reversal (HR) is associated with significant technical complexity and morbidity. The decision to perform HR is difficult and up to 50% of patients with colostomies do not undergo a reversal. To better guide surgeons and patients with this decision, we sought to assess the surgical risks and outcomes of HR as compared to elective left colectomy (LC).
Methods
We conducted a retrospective analysis of a prospective database at a tertiary medical center. Patients undergoing elective Hartmann’s reversal and left colectomy between January 2014 and November 2021 were identified. We compared preoperative variables, intraoperative events, and short-term postoperative outcomes.
Results
135 patients were identified: 30 HR and 105 LC. There were no significant differences in demographics or preoperative comorbidities between HR and LC. There were more open and fewer robotic cases in HR (23.3% vs 2.9%, P < .0001; 46.6% vs 76.0%, P < .01). Total operative time was significantly longer in HR than LC (261.8 vs 211.7 minutes, P = .02). There was a significantly higher percentage of intraoperative complications in HR (13.3% vs 1.9%, P < .01). There was a significantly higher rate of minor postoperative complications in HR than LC (46.7% vs 26.7%, P = .04), but not major (6.7% vs 5.8%, P = .85). Time to first flatus/bowel movement was significantly longer in HR than LC (3.6 vs 2.5 days, P < .001).
Conclusion
Hartmann’s reversal is a more technically challenging operation than elective left colectomy and is associated with significantly higher rates of intraoperative and minor postoperative complications. Future studies should focus on mitigating these risk factors to optimize patient outcomes.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/00031348221135777</identifier><identifier>PMID: 36321223</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Abdomen ; Anastomosis, Surgical - adverse effects ; Body mass index ; Cancer ; Colectomy - adverse effects ; Colostomy - adverse effects ; Comorbidity ; Complexity ; Complications ; Demographics ; Diverticulitis ; Health care facilities ; Heart attacks ; Hemorrhage ; Humans ; Intestinal obstruction ; Length of stay ; Morbidity ; Mortality ; Ostomy ; Pneumonia ; Postoperative ; Postoperative Complications - etiology ; Postoperative period ; Reoperation - adverse effects ; Retrospective Studies ; Risk analysis ; Risk factors ; Robotics ; Surgeons ; Surgery ; Surgical anastomosis ; Surgical outcomes ; Thrombosis ; Treatment Outcome ; Urinary retention ; Urinary tract diseases ; Urinary tract infections ; Urogenital system ; Variables</subject><ispartof>The American surgeon, 2023-02, Vol.89 (2), p.224-229</ispartof><rights>The Author(s) 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c320t-bdf698ff697f765926f8a14a75b4e95bbdfd71fc89e5578093c7871be118d7b03</cites><orcidid>0000-0002-1209-7511</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/00031348221135777$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/00031348221135777$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36321223$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nasseri, Yosef</creatorcontrib><creatorcontrib>Liu, Andy</creatorcontrib><creatorcontrib>Kasheri, Eli</creatorcontrib><creatorcontrib>Oka, Kimberly</creatorcontrib><creatorcontrib>Cohen, Jason</creatorcontrib><creatorcontrib>Ellenhorn, Joshua</creatorcontrib><creatorcontrib>Bergamaschi, Roberto</creatorcontrib><creatorcontrib>Barnajian, Moshe</creatorcontrib><title>Hartmann’s Reversal is More Complex Than Elective Left Colectomy</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>Background
Hartmann’s reversal (HR) is associated with significant technical complexity and morbidity. The decision to perform HR is difficult and up to 50% of patients with colostomies do not undergo a reversal. To better guide surgeons and patients with this decision, we sought to assess the surgical risks and outcomes of HR as compared to elective left colectomy (LC).
Methods
We conducted a retrospective analysis of a prospective database at a tertiary medical center. Patients undergoing elective Hartmann’s reversal and left colectomy between January 2014 and November 2021 were identified. We compared preoperative variables, intraoperative events, and short-term postoperative outcomes.
Results
135 patients were identified: 30 HR and 105 LC. There were no significant differences in demographics or preoperative comorbidities between HR and LC. There were more open and fewer robotic cases in HR (23.3% vs 2.9%, P < .0001; 46.6% vs 76.0%, P < .01). Total operative time was significantly longer in HR than LC (261.8 vs 211.7 minutes, P = .02). There was a significantly higher percentage of intraoperative complications in HR (13.3% vs 1.9%, P < .01). There was a significantly higher rate of minor postoperative complications in HR than LC (46.7% vs 26.7%, P = .04), but not major (6.7% vs 5.8%, P = .85). Time to first flatus/bowel movement was significantly longer in HR than LC (3.6 vs 2.5 days, P < .001).
Conclusion
Hartmann’s reversal is a more technically challenging operation than elective left colectomy and is associated with significantly higher rates of intraoperative and minor postoperative complications. Future studies should focus on mitigating these risk factors to optimize patient outcomes.</description><subject>Abdomen</subject><subject>Anastomosis, Surgical - adverse effects</subject><subject>Body mass index</subject><subject>Cancer</subject><subject>Colectomy - adverse effects</subject><subject>Colostomy - adverse effects</subject><subject>Comorbidity</subject><subject>Complexity</subject><subject>Complications</subject><subject>Demographics</subject><subject>Diverticulitis</subject><subject>Health care facilities</subject><subject>Heart attacks</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Intestinal obstruction</subject><subject>Length of stay</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Ostomy</subject><subject>Pneumonia</subject><subject>Postoperative</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative period</subject><subject>Reoperation - adverse effects</subject><subject>Retrospective Studies</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Robotics</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical anastomosis</subject><subject>Surgical outcomes</subject><subject>Thrombosis</subject><subject>Treatment Outcome</subject><subject>Urinary retention</subject><subject>Urinary tract diseases</subject><subject>Urinary tract infections</subject><subject>Urogenital system</subject><subject>Variables</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kM9Kw0AQxhdRbK0-gBcJePGSurObzW6OWqoVKoLUc9gkE43kT91Nir35Gr6eT-KGVgXFywzD95tvho-QY6BjACnPKaUceKAYA-BCSrlDhiCE8CPF-C4Z9rrfAwNyYO2zG4NQwD4Z8JAzYIwPyeVMm7bSdf3x9m69e1yhsbr0CuvdNga9SVMtS3z1Fk-69qYlpm2xQm-Oeeukfmyq9SHZy3Vp8WjbR-TharqYzPz53fXN5GLup5zR1k-yPIxU7orMZSgiFuZKQ6ClSAKMROL0TEKeqgiFkIpGPJVKQoIAKpMJ5SNytvFdmualQ9vGVWFTLEtdY9PZmEkOAVMq5A49_YU-N52p3XeOCgWLBHX-IwIbKjWNtQbzeGmKSpt1DDTuA47_BOx2TrbOXVJh9r3xlagDxhvA6kf8Ofu_4yesPoFX</recordid><startdate>202302</startdate><enddate>202302</enddate><creator>Nasseri, Yosef</creator><creator>Liu, Andy</creator><creator>Kasheri, Eli</creator><creator>Oka, Kimberly</creator><creator>Cohen, Jason</creator><creator>Ellenhorn, Joshua</creator><creator>Bergamaschi, Roberto</creator><creator>Barnajian, Moshe</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7T7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1209-7511</orcidid></search><sort><creationdate>202302</creationdate><title>Hartmann’s Reversal is More Complex Than Elective Left Colectomy</title><author>Nasseri, Yosef ; Liu, Andy ; Kasheri, Eli ; Oka, Kimberly ; Cohen, Jason ; Ellenhorn, Joshua ; Bergamaschi, Roberto ; Barnajian, Moshe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c320t-bdf698ff697f765926f8a14a75b4e95bbdfd71fc89e5578093c7871be118d7b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdomen</topic><topic>Anastomosis, Surgical - adverse effects</topic><topic>Body mass index</topic><topic>Cancer</topic><topic>Colectomy - adverse effects</topic><topic>Colostomy - adverse effects</topic><topic>Comorbidity</topic><topic>Complexity</topic><topic>Complications</topic><topic>Demographics</topic><topic>Diverticulitis</topic><topic>Health care facilities</topic><topic>Heart attacks</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Intestinal obstruction</topic><topic>Length of stay</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Ostomy</topic><topic>Pneumonia</topic><topic>Postoperative</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative period</topic><topic>Reoperation - adverse effects</topic><topic>Retrospective Studies</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Robotics</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical anastomosis</topic><topic>Surgical outcomes</topic><topic>Thrombosis</topic><topic>Treatment Outcome</topic><topic>Urinary retention</topic><topic>Urinary tract diseases</topic><topic>Urinary tract infections</topic><topic>Urogenital system</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nasseri, Yosef</creatorcontrib><creatorcontrib>Liu, Andy</creatorcontrib><creatorcontrib>Kasheri, Eli</creatorcontrib><creatorcontrib>Oka, Kimberly</creatorcontrib><creatorcontrib>Cohen, Jason</creatorcontrib><creatorcontrib>Ellenhorn, Joshua</creatorcontrib><creatorcontrib>Bergamaschi, Roberto</creatorcontrib><creatorcontrib>Barnajian, Moshe</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nasseri, Yosef</au><au>Liu, Andy</au><au>Kasheri, Eli</au><au>Oka, Kimberly</au><au>Cohen, Jason</au><au>Ellenhorn, Joshua</au><au>Bergamaschi, Roberto</au><au>Barnajian, Moshe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hartmann’s Reversal is More Complex Than Elective Left Colectomy</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2023-02</date><risdate>2023</risdate><volume>89</volume><issue>2</issue><spage>224</spage><epage>229</epage><pages>224-229</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>Background
Hartmann’s reversal (HR) is associated with significant technical complexity and morbidity. The decision to perform HR is difficult and up to 50% of patients with colostomies do not undergo a reversal. To better guide surgeons and patients with this decision, we sought to assess the surgical risks and outcomes of HR as compared to elective left colectomy (LC).
Methods
We conducted a retrospective analysis of a prospective database at a tertiary medical center. Patients undergoing elective Hartmann’s reversal and left colectomy between January 2014 and November 2021 were identified. We compared preoperative variables, intraoperative events, and short-term postoperative outcomes.
Results
135 patients were identified: 30 HR and 105 LC. There were no significant differences in demographics or preoperative comorbidities between HR and LC. There were more open and fewer robotic cases in HR (23.3% vs 2.9%, P < .0001; 46.6% vs 76.0%, P < .01). Total operative time was significantly longer in HR than LC (261.8 vs 211.7 minutes, P = .02). There was a significantly higher percentage of intraoperative complications in HR (13.3% vs 1.9%, P < .01). There was a significantly higher rate of minor postoperative complications in HR than LC (46.7% vs 26.7%, P = .04), but not major (6.7% vs 5.8%, P = .85). Time to first flatus/bowel movement was significantly longer in HR than LC (3.6 vs 2.5 days, P < .001).
Conclusion
Hartmann’s reversal is a more technically challenging operation than elective left colectomy and is associated with significantly higher rates of intraoperative and minor postoperative complications. Future studies should focus on mitigating these risk factors to optimize patient outcomes.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>36321223</pmid><doi>10.1177/00031348221135777</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-1209-7511</orcidid></addata></record> |
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| subjects | Abdomen Anastomosis, Surgical - adverse effects Body mass index Cancer Colectomy - adverse effects Colostomy - adverse effects Comorbidity Complexity Complications Demographics Diverticulitis Health care facilities Heart attacks Hemorrhage Humans Intestinal obstruction Length of stay Morbidity Mortality Ostomy Pneumonia Postoperative Postoperative Complications - etiology Postoperative period Reoperation - adverse effects Retrospective Studies Risk analysis Risk factors Robotics Surgeons Surgery Surgical anastomosis Surgical outcomes Thrombosis Treatment Outcome Urinary retention Urinary tract diseases Urinary tract infections Urogenital system Variables |
| title | Hartmann’s Reversal is More Complex Than Elective Left Colectomy |
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