GS12 HARTMANN'S VS. STENT AND WASHOUT, A REVIEW OF 112 CASES

Abstract

Background: The aim is to compare the outcomes of surgical management of large bowel emergencies. The traditional treatment of Hartmann's resection was compared to the new modalities of Colonic stenting for malignant obstruction and laparoscopic washout for perforated sigmoid diverticulitis.Methods: This paper is a retrospective review of 112 consecutive large bowel emergencies presenting to The Tweed Hospital and John Flynn Private Hospital warranting surgical intervention during the 8 year period 2000–2008. Patients with obstruction from cancer and perforation from diverticulitis were included. Patients with volvulus, pseudo‐obstruction, bleeding, stercoral ulceration and prolapse were excluded. Patients with non urgent colonic stenting were also excluded.Results: The patient groups were comparable for age, ASA and pathology after exclusions. 57 patients underwent a Hartmann's (obstruction 23, perforation 34) vs. 55 patients undergoing stent for obstruction 21, or washout for perforation 34. Significant differences were observed in the mortality rates, Hartmann's 11/57 (19%) vs. stent and washout 2/55 (37%). Also length of stay: Hartmann's 15 days vs. stent and washout 6 days. Hartmann's was required to salvage 2 failed stents and 6 failed washouts. In 16 of 26 washouts and 11 of 17 stents patients underwent delayed elective resection.Conclusion: Patient selection, technical expertise and long learning curve were all aspects that influenced the early results of stenting and washout. Hartmann's is no longer the preferred treatment option for left sided colonic emergencies.