Estado actual de la intervención de Hartmann en nuestro medio

Abstract

The therapeutic alternatives in emergency surgery of the colon are a constant subject of debate and the Hartmann procedure is one of the most controversial techniques. The aim of the present study was to analyze when, why and in whom this procedure is performed, as well as its results. We performed a descriptive analysis of 105 emergency Hartmann procedures. Clinical variables (age, sex, antecedents, symptoms, risk factors, preoperative diagnosis) were analyzed and correlated with surgical variables (surgical findings, surgeon) indicating the Hartmann procedure depending on general and local factors. The mean age was 69.3 years and 56% of the patients were men. Seventy-three percent had personal antecedents. Presenting symptoms were occlusion in 48%, acute abdomen in 30% and septic shock in 12%. Seventy-eight percent were ASA III-IV. The most frequent surgical findings were intestinal occlusion (39%), purulent peritonitis (22%) and fecal peritonitis (18%). Perforation of the colon was found in 14%. Morbidity was 51% and mortality was 11%. Sixty-three percent of the procedures were performed by general surgeons and 37% by specialists in colorectal surgery. In 20 patients intestinal continuity was restored after a mean wait of 9 months. Retrospective evaluation of the indications for the Hartmann procedure revealed that 50.5% of the patients could have undergone anastomosis and the reasons for not performing this procedure were analyzed. In our experience the Hartmann procedure is performed primarily for factors related to the patient (risk factors, general status and local status of the abdomen) and secondly due to factors related to the duty surgeon.