TH3.3 “Closing the loop”: what is the delay in Reversal of Hartmann's procedure?

Abstract

Reversal of Hartmann's procedure is performed to restore intestinal continuity. There is conflicting literature on the best time for reversal, with little evidence suggesting waiting longer than a year is beneficial. We assessed the experience of our patients.Patients were identified from the local Enhanced Recovery After Surgery (ERAS) database over a 9-year period (2012–2021) at a University Hospital. Data was collected from digitalised hospital notes on patient demographics; timings to reversal of Hartmann's; defunctioning stoma; reasons for delay; length of stay; and complications.Forty-three patients underwent reversal of Hartmann's procedure. Median age was 57 (38–83) years; 19 (44%) of patients were female. Surgery was performed laparoscopically in 18 (42%); laparoscopic converted to open 6 (14%); open in 19 (44%) patients. Average length of stay was 6 days. Indications for primary Hartmann's procedure were diverticular disease (67%), malignancy (21%), and other causes (14%). Median time from the index operation to reversal of Hartmann's was 85.2 weeks (range 19.9–312.4 weeks). Only 9 (21%) patients underwent reversal Hartmann's within 1 year of primary surgery. Of the reasons known for the delay in reversal; 15 (35%) were due to patient complications, 6 (14%) were due to administrative reasons, 2 (5%) were due to COVID-19 associated delays and 1 (2%) patient choice.This retrospective analysis highlights the varied patient experience within just one centre, further research incorporating detailed patient experience is needed. It also highlights a paucity of national evidence-based consensus on optimal timing for challenging revisional surgery.