Reversal of Hartmann's procedure: timelines, preoperative investigations and early outcomes. A single Australian institution's ten-year experience.

Abstract

Real-world data on outcomes following Hartmann's reversal is necessary to help optimize the patient experience. We have explored the timing between the index operation and its reversal; what investigations were carried out prior to this, and the associated short-term outcomes. A retrospective study of all patients who underwent Hartmann's reversal from 2010 to 2020 within a tertiary referral centre in Melbourne, Australia. One hundred from a total of 406 (25%) who underwent an emergency Hartmann's procedure had a subsequent reversal. Complete patient data was available for 83 of these patients. The average patient age was 60 years, and the median time for reversal was 14.0 (IQR 10-23) months. Seventy-nine of 83 (95%) reversals had a preoperative endoscopic evaluation of both their rectal stump and a complete colonoscopy. Stoma stenosis (n=2), patient refusal (n=1) and emergency reversal (n=1) were cited reasons for not undergoing preoperative endoscopic evaluation. A third (n=28, 34%) had a computed tomography prior to reversal; the majority was due to their underlying cancer surveillance (n=21, 75%). Reversal was associated with a morbidity rate of 47% (n=39). Surgical site infections (SSIs) (n=21, 25%) were the most common type of complications encountered, with the majority being superficial (n=15, 71%). SSIs were associated with steroid use (5/21 versus 4/62, p=0.03) and greater hospital length of stay (6 versus 10 days, p=0.03). Only a quarter of emergency Hartmann's procedures within our institution were reversed. A significant proportion developed postoperative complications. Surgical site infection was the most common morbidity.