Hartmann's Reversal Research Articles

Single-port laparoscopic reversal of Hartmann's procedure through the colostomy site: technical aspects and early postoperative outcomes.

Single-port laparoscopic surgical approaches offer improved cosmetic outcomes and enhance recovery following surgery. The purpose of the study was to assess the reliability and efficacy of a single-port laparoscopic Hartmann's reversal(SPL-HR) through the colostomy site. Prospective data from consecutive patients who underwent SPL-HR between 2020 and 2024 was analysed. Once the colostomy was detached from abdominal wall, a single-port device was introduced through the colostomy site. After mobilizing the rectal stump and afferent colon, colorectal anastomosis was carried out using a circular stapler transanally under laparoscopic vision. Postoperative care and discharge decisions were made following the ERAS protocol. Patient demographics, details of Hartmann's procedure, intraoperative outcomes, and early postoperative outcomes were evaluated. SPL-HR was successfully performed in 23 of 27 patients (85.1%), with a median operation time of 92 (50-172) min and a median blood loss of 100 (10-360) mL. Five patients (21.7%) experienced a postoperative complication. Two of them experienced grade 3a complications according to Clavien-Dindo classification: one with an intraabdominal abscess and one with a hematoma at the colostomy site, both requiring drainage under local anaesthesia. Anastomotic leak or mortality wasn't observed in patients. Functional recovery measures such as first flatus time and time to resuming a soft diet were favourable, with a median length of hospital stay of 4 (2-9) days. The SPL-HR technique is a reliable and efficient method that is easy to perform. It has acceptable complication rates while improving postoperative recovery and reducing the length of hospital stay.

Laparoscopic Hartmann's Reversal After Perforated Sigmoid Diverticulitis in a Woman.

Laparoscopic Hartmann's Reversal After Perforated Sigmoid Diverticulitis in a Woman.

Abdominal Hartmann reversal versus combined transanal/abdominal approach: Outcomes and technical notes

Background: Hartmann’s reversal (HR) is one of the most technically challenging operations in colorectal surgery. A small percentage of HR operations are performed laparoscopically. The pelvic dissection is the key point of the procedure and can be demanding when the rectal stump is extraperitoneal and if the pelvic condition is complex. Methods: A retrospective observational single-center study was designed to analyze the outcomes of patients with an extraperitoneal rectal stump who underwent HR from January 2015 to December 2020 at IRCCS Sacro Cuore Don Calabria Hospital in Negrar of Valpolicella. The patients were divided into two groups: group 1 underwent a purely abdominal Hartmann’s reversal (A-HR) and group 2 underwent a combined transanal and abdominal Hartmann’s reversal (TA-HR). Results: Forty-two patients were divided into the groups as follows: 22 (52.3%) patients in the A-HR group versus 20 (47.62%) patients in the TA-HR. The transanal approach did not significantly affect the operative time. The rate of rectovaginal fistula was higher in the TA-HR group (65% vs. 4.5%). The anastomosis was performed mechanically in all A-HR cases and 50% of TA-HR patients (P < 0.01). No difference in temporary stoma creation was found. The rate of complications was lower in the TA-HR group (P = 0.05). The A-HR group was statistically significantly associated with redo surgery (P = 0.04). Stoma failure rate at the end of the follow-up did not differ between the two groups. Conclusions: Transanal Hartmann reversal seems to be a safe approach in patients with a complex pelvis and extraperitoneal rectal stump.

Laparoscopic Hartmann reversal: A single center experience in a developing country

Laparoscopic Hartmann reversal: A single center experience in a developing country

The effect of adhesiolysis on stoma takedown in patients with end colostomy

AIM: the optimal extent of adhesiolysis for stoma takedown after Hartmann’s procedure is still unknown. This study is for evaluation the early and late results after partial and total dissection of adhesions during Hartmann’s reversal (HR).PATIENTS AND METHODS: a prospective non-randomized study included 99 patients with end colostomy. Fifty patients were included in the main group, in which partial adhesiolysis was performed during HR, and 49 — were the control group, in which complete dissection of adhesions was performed. The groups did not differ in the basic demographic characteristics, number of previous operations, and the severity of the adhesions.RESULTS: the operation time in the groups of partial and total adhesiolysis was 222 vs 205 minutes, respectively (p = 0.9). Injury of the intestinal wall occurred in 18 patients in the main group, and in 19 controls (p = 0.8). The postoperative stay was 12 in the main group vs 11 in the control (p = 0.7). The morbidity rate in the main group was 42% (n = 21), in controls — 29% (n = 14) (p = 0.2). Reoperations were performed in 4 patients of the main group, no reoperations in the control group were required, but no significant differences were obtained (p = 0.5). In the group of partial adhesiolysis, 1 fatal outcome was registered. By the regression analysis, the only factor increasing the likelihood of postoperative complications was a BMI > 35 kg/m2 (OR = 5.3; 95% CI: 1.5–21.2; p = 0.01).CONCLUSION: total adhesiolysis does not affect the operation time and traumatism of Hartmann reversal, does not increase morbidity rate.

Body composition assessment by artificial intelligence can be a predictive tool for short-term postoperative complications in Hartmann’s reversals

BackgroundHartmann's reversal, a complex elective surgery, reverses and closes the colostomy in individuals who previously underwent a Hartmann's procedure due to colonic pathology like cancer or diverticulitis. It demands careful planning and patient optimisation to help reduce postoperative complications. Preoperative evaluation of body composition has been useful in identifying patients at high risk of short-term postoperative outcomes following colorectal cancer surgery. We sought to explore the use of our in-house derived Artificial Intelligence (AI) algorithm to measure body composition within patients undergoing Hartmann’s reversal procedure in the prediction of short-term postoperative complications.MethodsA retrospective study of all patients who underwent Hartmann's reversal within a single tertiary referral centre (Western) in Melbourne, Australia and who had a preoperative Computerised Tomography (CT) scan performed. Body composition was measured using our previously validated AI algorithm for body segmentation developed by the Department of Surgery, Western Precinct, University of Melbourne. Sarcopenia in our study was defined as a skeletal muscle index (SMI), calculated as Skeletal Muscle Area (SMA) /height2 < 38.5 cm2/m2 in women and < 52.4 cm2/m2 in men.ResultsBetween 2010 and 2020, 47 patients (mean age 63.1 ± 12.3 years; male, n = 28 (59.6%) underwent body composition analysis. Twenty-one patients (44.7%) were sarcopenic, and 12 (25.5%) had evidence of sarcopenic obesity. The most common postoperative complication was surgical site infection (SSI) (n = 8, 17%). Sarcopenia (n = 7, 87.5%, p = 0.02) and sarcopenic obesity (n = 5, 62.5%, p = 0.02) were significantly associated with SSIs. The risks of developing an SSI were 8.7 times greater when sarcopenia was present.ConclusionSarcopenia and sarcopenic obesity were related to postoperative complications following Hartmann’s reversal. Body composition measured by a validated AI algorithm may be a beneficial tool for predicting short-term surgical outcomes for these patients.

Contemporary management of diverticulitis

The treatment of diverticulitis is experiencing a shift in management due to a number of large scale clinical trials. For instance, clinicians are beginning to recognize that avoidance of antibiotics in uncomplicated diverticulitis is not associated with worse outcomes. Additionally, while the decision to proceed with elective surgical resection for recurrent uncomplicated disease is less conclusive and favors a patient-centric approach, complicated disease with a large abscess denotes more aggressive disease and would likely benefit from elective surgical resection. Lastly, in patient with acutely perforated diverticulitis who require urgent surgical intervention, laparoscopic lavage is generally not recommended due to high re-intervention rates and the preferred surgical procedure is primary anastomosis with or without diversion due to high morbidity and low rates of Hartmann reversal.

The Pivotal Role of Negative Pressure Wound Therapy in the Management of Enteroatmospheric Fistula: A Year-Long "Obstacle Marathon"

Background. Enteroatmospheric fistula (EAF) is an abnormal communication between the gastrointestinal tract and the atmosphere. This phenomenon is still considered one of the most significant challenges faced by general surgeons after abdominal surgery. Primary goals of managing EAF include controlling and diverting intestinal contents outside the abdominal cavity, protecting surrounding tissues from retraction, and promoting wound healing. Achieving these goals is not easy. EAF has a 40% mortality rate. Several techniques have been proposed for managing this problem, including negative pressure wound therapy. The use of bladder catheters, nipples, endoscopic stents, vascular grafts, and fistula funnel, among other options, in the management of EAF has also been described. Case Report. The patient in the current report underwent Hartmann reversal surgery. On postoperative day (POD) 5, he had an anastomotic leak with ischemia of the descending colon and the transverse colon. Resection of the ischemic colon was performed, followed by creation of a terminal ileostomy on the last ileal loop on the right side. The first small orifice of EAF appeared on POD 23, the second on POD 28, and the third on POD 45. On POD 253, the patient underwent resection of the fistulated loop, extensive vitreolysis of the entire small intestine, and mechanical jejunojejunal laterolateral anastomosis to reestablish the canalization toward the previous terminal ileostomy on the right side. Complete closure of the skin was evident on POD 358. Conclusion. There is no ideal treatment approach that is valid for all cases of EAF. Spontaneous closure of an EAF is unlikely but feasible in the setting of a single, deep lesion with limited output and when intestinal continuity is preserved.

Use of a 5-Item Modified Frailty Index for Assessing Outcomes After Hartmann's Reversal: An ACS-NSQIP Study.

Half of all patients with an end colostomy after sigmoid colectomy (Hartmann's procedure) never undergo Hartmann's reversal, frequently secondary to frailty. This retrospective cohort study evaluates the utility of a five-item modified frailty index (mFI-5) in predicting post-operative outcomes after Hartmann's reversal. The National Surgery Quality Improvement Program (NSQIP) database captured patients with elective Hartmann's reversals from 2011 to 2020. Clinical covariates were evaluated with univariate analysis and modified Poisson regression to determine association with overall morbidity, overall mortality, and extended length of stay (eLOS) when categorized by mFI-5 score. 15,172 patients underwent elective Hartmann's reversal (91.6% open and 8.4% laparoscopic). Patients were grouped by mFI-5 score (0: 48.7%, 1: 38.2%, ≥ 2: 13.1%). Adjusted multivariable analysis showed frail patients (mFI-5≥2) had increased overall mortality (OR 2.23, 95% CI 1.21-4.11), morbidity (OR 1.23, 95% CI 1.12-1.35), and eLOS (OR 1.12, 95% 1.02-1.23). Among frail patients, a laparoscopic approach was associated with decreased overall morbidity (OR .64, 95% CI 0.56-.73) and decreased eLOS (OR .46, 95% CI 0.39-.54) when compared to open approach. An mFI-5 of ≥2 was associated with greater morbidity, mortality, and eLOS following Hartmann's reversal. However, there were no mortality or eLOS differences in patients with an mFI-5 of 1 and only a 14% increase in any morbidity, making these patients potentially good candidates for Hartmann's reversal. Furthermore, laparoscopic surgery was associated with a protective effect for overall morbidity and eLOS, potentially mitigating some of the risk associated with higher frailty scores.

Robotic Hartmann's reversal-feasibility and technical aspects.

Hartmann's reversal as a staged procedure after emergency surgery is a major abdominal operation with undeniable skill-demanding steps. The robotic approach and its advantages seem to be a safe and feasible technique and could overcome necessary technical compromises of laparoscopy, ensuring a significant reduction in restoration failures or conversion.

Adhesiolysis during reconstructive interventions in patients after Hartmann’s procedure (interim results of a randomized trial)

The purpose of this work was to evaluate the preliminary results of Hartmann reversal procedures with total and partial adhesiolysis in the abdominal cavity. 64 patients with end colostomies were included in the randomized study from November 2021 to December 2022; 37 patients underwent partial adhesiolysis (main group) during the intervention, and 27 patients underwent complete adhesiolysis (control group). The study groups were comparable in gender, BMI, and status on the ASA scale. During the study, postoperative complications developed in 13 (35 %) cases in the group of partial adhesiolysis and in 6 (22 %) cases in the group of complete adhesiolysis (p = 0.4). In both groups, complications of classes I and II on the Clavien-Dindo scale prevailed. Complications requiring repeated surgical interventions developed in 3 patients of the main group: an anastomotic leak was detected in 2 (5 %) patients, and colon perforation was detected in 1 (3 %) patient, however, the groups were comparable in this parameter (p = 0.6). There was no statistically significant difference in the frequency and structure of postoperative complications or the duration of the postoperative inpatient days between the groups. The volume of adhesiolysis did not affect the duration of surgical interventions, which accounted for 224 minutes in the main group and 200 minutes in the control group. According to the results of regression analysis, the presence of previous peritonitis turned out to be the only predictor that increases the likelihood of postoperative complications (OR = 0.33; 95 % CI: 0.1–1; p = 0.049). Thus, the preliminary results of the randomized study showed no impact of the volume of adhesiolysis on the duration of the intervention and the nature and frequency of postoperative complications.Further research is necessary.

Safety of early Hartmann reversal during adjuvant chemotherapy in colorectal cancer: a pilot study.

Most patients undergoing the Hartmann procedure for complicated colorectal cancer require chemotherapy because of their advanced status. Stoma created during the procedure is typically closed after the completion of postoperative chemotherapy. However, stomas can induce medical or surgical complications and disturb quality of life. This study aimed to evaluate the safety of Hartmann's reversal during postoperative chemotherapy. We conducted a retrospective review of electronic medical records. Between 2017 and 2021, 96 patients underwent Hartmann reversal for after colorectal cancer surgery. Among them, the number of patients who underwent Hartmann procedure with radical resection of complicated colorectal cancer and Hartmann reversal during adjuvant chemotherapy was 13. The clinical, surgical, and pathological characteristics of the patients were evaluated. Eight and five patients had obstructions and perforations, respectively. Two patients with synchronous liver metastases underwent simultaneous liver resection and reversal simultaneously. Five and eight patients received adjuvant chemotherapy with capecitabine and FOLFOX, respectively. The median interval between the Hartmann procedure and reversal was 3.31 months (2.69-5.59). The median operative time for Hartmann's reversal was 190 min (100-335). The median hospital stay was 10 days (7-21). Four patients (30.8%) developed postoperative complications, and the rate of 3 or higher grade according to the Clavien-Dindo classification within 90 days postoperatively was 0%. Except for 1 patient who refused continuation of chemotherapy, 12 patients completed the planned chemotherapy. Median total duration of adjuvant chemotherapy was 6.78 months (5.98-8.48). There was no mortality. Early Hartmann reversal during adjuvant chemotherapy is tolerable and safe in carefully selected patients. In particular, it can be used as a therapeutic option for patients with complicated colorectal cancer with synchronous resectable metastases.

One-step totally robotic Hartmann reversal and complex abdominal wall reconstruction with bilateral posterior component separation: a technical note.

This paper describes a robotic approach to combined gastrointestinal continuity restoration and complex abdominal wall reconstruction after Hartmann's procedure complicated by large midline and parastomal hernias. A robotic Hartmann reversal is performed, followed by robotic retromuscular abdominal wall reconstruction of all ventral defects with bilateral posterior component separation using the double-docking approach. Surgical steps are thoroughly described, and the accompanying video highlights critical steps of the procedure, anatomical landmarks and technical details relevant to successful completion. Complete restoration of the anatomy was achieved with an operative time of 6.5 h. Mobilization occured on day 1, and bowels were opened on day 3. Surgical discharge was possible on day 5. No intra-operative surgical complication occurred and follow-up at 6 months showed no recurrence or mid-term complication. Combined minimally invasive reconstruction of the gastrointestinal tract and abdominal wall was feasible using a robotic system. In addition, potential advantages of postoperative rehabilitation and reduced surgical site complications are suggested. Prospective evaluation of the technique is ongoing.

OC-032 SAFETY OF PERFORMING CONCOMITANT GASTROINTESTINAL RESECTIONAL SURGERY WITH COMPLEX ABDOMINAL WALL RECONSTRUCTION

Abstract Aim The literature regarding combined complex abdominal wall reconstruction (CAWR) and gastrointestinal surgery (GIS) is limited and largely suggests staged procedures due to a reported increased incidence of surgical site occurences (SSO), hernia recurrence and anastomotic leak. However this exposes patients to the risks of two substantial procedures and having general anaesthetic twice. This study aimed to evaluate outcomes of single-stage GIS involving a substantial GI resection with CAWR. Materials &amp; Methods Analysis of a 8 years prospectively maintained single surgeon CAWR database of 205 patients identified 14 such patients who had undergone concomitant CAWR GIS cases (5 segmental colonic resections, 2 completion proctectomies, 5 Hartmann's reversals and 2 small bowel resection and anastomoses) but excluding cholecystectomy, gynaecological surgery and adhesiolysis alone. Results CAWR-GIS mean operating time was significantly longer (5.8hrs vs 3.8hrs) with an increased incidence of post-operative ileus (40% vs 18%, p&amp;lt;0.05) with increased mean length of stay as expected (7.8 days v/s 5.1 days). There was a slightly higher incidence of SSO but there were no anastomotic leaks. Hernia recurrence rate at 2 years follow up was 10% which is comparable to our cohort (8%). None of the 14 patients required reoperation within 30 days or mesh explantation yet. 11 patients had a synthetic mesh and 3 patients had a bio-synthetic mesh used. Patients informally reported high satisfaction for having undergone combined procedures. Conclusion Concomitant intestinal surgery during complex abdominal wall repair can be performed safely without increased risk of hernia recurrence, mesh infections or anastomotic leak.

V-041 ROBOTIC MONOLATERAL TAR FOR LATERAL INCISIONAL HERNIA IN PREVIOUS COLOSTOMY SITE

Abstract Background Novitsky described the Transversus Abdominis Muscle release (TAR) extending the retromuscolar plane (RMP) improving the midline restoration (MR) with high morbidity. The robotic approach seems to have the same effectiveness reducing wound complications. Video's comment A 58-year-old male submitted to Hartmann procedure for acute diverticulitis, developed an incisional hernia (IH) (3cm width) on colostomy site, L2-W1 according to IH-EHS classification and an umbilical IH of 2cm width (EHS classification: M3-W1), after Hartmann reversal. We planned the abdominal wall repair with R-TAR by drawing on the skin the dimension of the mesh with an overlap of 7cm from the defect, helping us to orient the dissection using transfascial needles. After the pneumoperitoneum created and the lateral-right sided-docking of Da Vinci Xi, we incised the lateral edge of right posterior rectus sheet (PRS) and dissected the RMP. The incision of the medial edge of the PRS and the identification of the linea alba allows the crossing-over to the contralateral RMP. We reduced the umbilical IH and dissected completely the left RMP to the flank defect and the Neurovascular Boundles. We started the division of TA fibers and we dissected the preperitoneal plane beyond the IH sac and to the arcuate line. We closed the defects with a 0-vloc and the peritoneum with a 3/0-vloc both barbed. We implanted a 15×30 Progrip selfigripping mesh and we closed the peritoneal-flap with a 2/0-vloc barbed suture. The patient was discharged in 2 days and any complication were recorded after 30 days.

V08-04 UROLOGIC COMPLICATIONS DURING HARTMANN REVERSAL PROCEDURE: ROBOTIC-ASSISTED MANAGEMENT OF TWO CASES OF ENTEROVESICAL FISTULAE

You have accessJournal of UrologyCME1 Apr 2023V08-04 UROLOGIC COMPLICATIONS DURING HARTMANN REVERSAL PROCEDURE: ROBOTIC-ASSISTED MANAGEMENT OF TWO CASES OF ENTEROVESICAL FISTULAE Jaime Poncel, Aref S. Sayegh, Alexandre K. Hidaka, Maria A. Lizana, Sij Hemal, Luis G. Medina, and Rene Sotelo Jaime PoncelJaime Poncel More articles by this author , Aref S. SayeghAref S. Sayegh More articles by this author , Alexandre K. HidakaAlexandre K. Hidaka More articles by this author , Maria A. LizanaMaria A. Lizana More articles by this author , Sij HemalSij Hemal More articles by this author , Luis G. MedinaLuis G. Medina More articles by this author , and Rene SoteloRene Sotelo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hartmann procedure is the resection of the rectosigmoid colon, closure of the rectal stump, and creation of an end colostomy. Unfortunately, a Hartmann reversal to re-establish intestinal continuity carries high morbidity with a complication rate of up to 58%. Urological complications during Hartmann’s reversal procedure are rare however low rates of bladder injury (8.16-16%) and fistula formation (0.6-4.08%) have been reported in the literature. This video presents a step-by-step robotic surgical technique for the repair of two entero-vesical fistulae likely caused due to the incorrect use of the circular surgical stapler during a Hartmann’s reversal. METHODS: Two consecutive cases of entero-vesical fistulae were treated through a novel robotic transabdominal approach by a single surgeon. Surgical steps were performed as illustrated in the video. Perioperative and functional outcomes were evaluated and reported. Continuous variables were reported as median and quartiles, whereas categorical variables were presented as frequencies and percentages. RESULTS: Two cases are reported with a median age of 71 (59-83). Both surgeries were uneventful with no intraoperative complications reported. Median operative time estimated blood loss, and length of stay were 557 (454-660) minutes, 150 (100-200) cc, and 3 (2-4) days, respectively. Median Jackson-Pratt drain removal time was 6.5 (4-9) days. Median catheter removal time was 18 (14-22) days. One case of urinary tract infection occurred during the postoperative period, which was successfully treated. No fistula recurrence was reported. CONCLUSIONS: Hartmann reversal is a morbid procedure that carries a small risk of urological complications, which may have a significant impact on patient's quality of life. Herein, we present the robotic-assisted management of enterovesical fistula formation following two Hartmann reversals and demonstrate the feasibility and safety of utilizing a minimally invasive approach. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e749 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jaime Poncel More articles by this author Aref S. Sayegh More articles by this author Alexandre K. Hidaka More articles by this author Maria A. Lizana More articles by this author Sij Hemal More articles by this author Luis G. Medina More articles by this author Rene Sotelo More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of a digital surgical workflow including Digital Device Briefing Tool on morbidity and mortality in a patient population undergoing primary stapled colorectal anastomosis for benign or malignant colorectal disease: protocol for a multicentre prospective cohort study

IntroductionWith growing emphasis on surgical safety, it appears fundamental to assess the safety of colorectal resection involving primary stapled anastomosis. Surgical stapling devices can considerably foster patient safety in colorectal...

Impact of Frailty on Patient Outcomes after Hartmann's Reversal: A NSQIP Analysis.

Colostomy reversal is a common procedure. Patients often have baseline comorbidities associated with postoperative morbidity. We utilized a modified frailty index (mFI-5) to predict postoperative complications. Patients who underwent elective, open Hartmann's reversal were queried from the National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified to low, medium, or high frailty groups. Statistical analysis was performed using chi-squared, ANOVA, and logistic regression. There were 9272 patients with Hartmann's reversal. 48.78%, 30.31%, and 12.89% had low, moderate, or high frailty, respectively. High frailty was associated with cardiac arrest, myocardial infarction, reintubation, prolonged intubation, early reoperation, and mortality. After multivariate analysis, high frailty was associated with prolonged intubation (OR 3.147, P = .001), reintubation (OR 2.548, P = .002), and reoperation (OR 1.67, P < .001). Frailty was associated with greater risk of postoperative complications in patients undergoing Hartmann's reversal. Frailty may be a useful adjunct to stratify for patients who are at risk for postoperative complications.

Laparoscopic versus open Hartmann reversal: a propensity score matching analysis.

The purpose of this study was to compare the short-term outcomes between laparoscopic Hartmann reversal (LHR) and open Hartmann reversal (OHR) in patients who had undergone Hartmann surgery for colorectal cancer (CRC). The patients who underwent Hartmann reversal (HR) at the First Affiliated Hospital of Chongqing Medical University from Jun 2013 to Jun 2022 were retrospectively enrolled. The LHR group and the OHR group were compared using propensity score matching (PSM) analysis. A total of 89 patients who underwent Hartmann reversal (HR) were enrolled in this study. There were 48 (53.9%) patients in the LHR group and 41 (46.1%) patients in the OHR group. After 1:1 ratio PSM, no difference in baseline information remained (p > 0.05). There was no significant difference in operation time, blood loss, postoperative hospital stay, and postoperative complications (p > 0.05) before and after PSM. In the multivariable logistic regression analysis, pre-operative albumin < 42.0g/L was an independent risk factor (p = 0.013 < 0.05, OR = 0.248, 95% CI = 0.083-0.741) for the HR-related complications; however, LHR/OHR was not a predictive risk factor (p = 0.663, OR = 1.250, 95% CI = 0.500-3.122). Based on the current evidence, although there was no difference in short-term prognosis, LHR still had some advantages considering that it was less invasive to the patient.

The Time Interval and Treatment Outcomes of Hartmann's Reversal Procedure

目的：ハルトマン手術（HP）後からハルトマンリバーサル手術（HR）を施行するまでの期間（インターバル期間）とHRの治療成績との関連について明らかにすること．方法：2009年9月から2021年12月までのHR 32例を対象とし，患者背景，HPおよびHR周術期の因子，治療成績を検討項目として，インターバル期間の短い症例（中央値以内）と長い症例（中央値よりも長い）との間で比較した．結果：インターバル期間の中央値は6ヵ月であった．Clavien-Dindo分類GradeIII以上の術後合併症は6例（19％）に発生した．インターバル期間の短い症例（N＝18）と長い症例（N＝14）との比較で，後者に併存疾患を2つ以上有する症例が有意に多かったが，術後合併症を含む治療成績に有意差はなかった．結語：インターバル期間を6ヵ月より延長しても，術後合併症を含む治療成績は改善しなかった．