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Background <p>Hartmann’s procedure is when all the sigmoid and/or rectum is removed with an end stoma in the left iliac fossa and the rectal stump closed off in the pelvis. This is often performed when bowel anastomosis is not feasible, too risky or deemed unsuitable for patients, either as planned operation or in an emergency, with reversal rate being less than 50%. The aim of our study was to establish the number of Hartmann’s procedure performed, its reversal rate in a single UK based NHS hospital, comparison between surgical approaches (laparoscopic vs. open) and evaluating short term clinical outcomes.</p> Methods <p>A retrospective cohort study was conducted over a period of 13 years and 4 months (1<sup>st</sup> Jan 2011–31<sup>st</sup> May 2024). Exposures were (1) reversal status (reversed vs. non-reversed) and (2) surgical approach to reversal (laparoscopic vs. open). Patient demographics including smoking status, comorbidities, ASA, Rockwood frailty score, WHO performance status, and surgical indication were extracted. Outcomes included 30-day Clavien-Dindo morbidity, anastomotic leak, return to theatre, length of stay, readmission rate, and 30 and 90-day mortality.</p> Results <p>A total of 172 patients underwent Hartmann’s procedure during the study period, of whom 90 (52.3%) were reversed. The median follow-up was 67.25 months (IQR +/- 87). Forty-seven patients died during follow-up, 38 (81%) of whom were in the non-reversed group. Patients undergoing reversal were significantly younger, with fewer comorbidities, better ASA, frailty, and performance scores. Of the 90 reversals, 25 were completed laparoscopically, 35 were converted from laparoscopic to open, and 30 were performed as planned open reversals. Laparoscopic reversal was associated with a significantly shorter median length of stay (+/- 4 days); however, there was no difference in 30-day Clavien-Dindo morbidity between groups. There were two anastomotic leaks (2.2%) and two failed reversals in the open group, and one 30-day mortality in the laparoscopic group.</p> Conclusions <p>Our single-centre UK experience shows higher rates of Hartmann’s reversal in younger, much fitter patients, shorter hospital stay in the laparoscopic reversal group, with acceptable short-term outcomes in both groups.</p>

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Hartmann’s procedure reversal rate and short-term outcomes: a single centre retrospective cohort study

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  • 发表日期：

    2026年4月30日

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  • Christopher C L Liao,
  • Balakrisanan Saravanan,
  • Fatima Ismail,
  • Matthew Farmer,
  • Vamsi R Velchuru

摘要

Background

Hartmann’s procedure is when all the sigmoid and/or rectum is removed with an end stoma in the left iliac fossa and the rectal stump closed off in the pelvis. This is often performed when bowel anastomosis is not feasible, too risky or deemed unsuitable for patients, either as planned operation or in an emergency, with reversal rate being less than 50%. The aim of our study was to establish the number of Hartmann’s procedure performed, its reversal rate in a single UK based NHS hospital, comparison between surgical approaches (laparoscopic vs. open) and evaluating short term clinical outcomes.

Methods

A retrospective cohort study was conducted over a period of 13 years and 4 months (1st Jan 2011–31st May 2024). Exposures were (1) reversal status (reversed vs. non-reversed) and (2) surgical approach to reversal (laparoscopic vs. open). Patient demographics including smoking status, comorbidities, ASA, Rockwood frailty score, WHO performance status, and surgical indication were extracted. Outcomes included 30-day Clavien-Dindo morbidity, anastomotic leak, return to theatre, length of stay, readmission rate, and 30 and 90-day mortality.

Results

A total of 172 patients underwent Hartmann’s procedure during the study period, of whom 90 (52.3%) were reversed. The median follow-up was 67.25 months (IQR +/- 87). Forty-seven patients died during follow-up, 38 (81%) of whom were in the non-reversed group. Patients undergoing reversal were significantly younger, with fewer comorbidities, better ASA, frailty, and performance scores. Of the 90 reversals, 25 were completed laparoscopically, 35 were converted from laparoscopic to open, and 30 were performed as planned open reversals. Laparoscopic reversal was associated with a significantly shorter median length of stay (+/- 4 days); however, there was no difference in 30-day Clavien-Dindo morbidity between groups. There were two anastomotic leaks (2.2%) and two failed reversals in the open group, and one 30-day mortality in the laparoscopic group.

Conclusions

Our single-centre UK experience shows higher rates of Hartmann’s reversal in younger, much fitter patients, shorter hospital stay in the laparoscopic reversal group, with acceptable short-term outcomes in both groups.