Morbidity and mortality of Hartmann's procedure for sigmoid volvulus at the University Hospital of Cocody, Abidjan

The restoration of intestinal continuity following Hartmann's procedure is associated with high morbidity and mortality rates and low restoration rate. To determine the causes of complications and deaths associated with Hartmann's procedure and the secondary restoration of digestive continuity for sigmoid volvulus. This was a retrospective study involving 25 patients treated for sigmoid volvulus according to Hartmann's procedure, from January 1998 to January 2008; at the Cocody university hospital, Abidjan (Cote d'Ivoire). The mortality and morbidity rates were assessed on the basis of the age, the duration of illness, the ASA (American Society of Anesthesiologists) score, the state of the sigmoid colon and peritoneal cavity. The mean age of the patients was 42.52 years (range: 22-77 years). The mean duration of illness was 02.80± 0.71 days (range: 06 hours to 07 days). Sixteen (64%) of the patients had an ASA score lower than III. The mean length of intervention was 209.75 min.±102.530 min. (range: 120 min. to 327 min). The mortality rate was 12% (n=3) in the Hartmann's procedure. The necrosis state of the sigmoid colon was not significantly associated with a higher death risk (p=0.071) but the contamination of the peritoneal cavity by stools (p=0.001) or an ASA score ≥3 (p=0.036) was significantly associated with a higher death risk. Infections of the operative site (42.86%) were the most common complications. The mean length of hospital stay was 12.05 ± 25.45 days. Eleven patients (50%) out of 22 had the intestinal continuity restored. The median time of restoration was 3.43 months (range: 3-12 months).The mortality rate among the restoration group was nil and the morbidity rate was 27.27% represented by parietal suppurations only. The mean length of hospital stay was 14 ± 2.83 days. Hartmann's procedure remains associated with an significant mortality. Morbidity, essentially arises from infections of the operative site. However the restoration of the intestinal continuity remains a sure intervention with an acceptable morbidity.