Utilization and outcomes of Hartmann's procedure in emergency left colon surgery: evaluating postoperative complications and stoma reversal rates

Abstract

OBJECTIVE: The aim of the study was to investigate the utilization and outcomes of Hartmann's procedure in the emergency left colon surgery with respect to other stoma interventions. PATIENTS AND METHODS: A total of 70 consecutive patients (mean±SD age: 71.1±15.5 years, 51.4% were males) who underwent emergency surgery for the left colon were included in this retrospective cohort study. Data on patient demographics, primary diagnosis, emergency surgery indication, operative risk, stoma type (Hartmann's procedure, primary anastomosis with diverting loop ileostomy, double-barreled ostomy), surgeon sub-specialty, postoperative complications, and stoma reversal time and rates were recorded. RESULTS: Hartmann's procedure (72.9%) was the most commonly utilized stoma type, followed by primary anastomosis with diverting loop ileostomy (14.3%) and double-barreled ostomy (10.0%), while primary anastomosis was performed only in 2.8% of patients. The stoma reversal rate was 25.0%, and the median time to stoma reversal was 10 months (range, 3 to 48 months). Hartmann's procedure was less commonly performed by colorectal surgeons than by general surgeons (35.3% vs. 68.4%, p=0.013) and was associated with a lower chance of stoma reversal compared to other stoma types, including primary anastomosis with diverting loop ileostomy and double-barreled ostomy (15.7% vs. 52.9%, p=0.006). CONCLUSIONS: In conclusion, our findings revealed that Hartmann's procedure, although performed less commonly by colorectal surgeons than by general surgeons, was still the most prevalent procedure applied for the surgical management of left colon emergencies, particularly in the setting of tumor-induced obstruction or perforation, despite the potential risk of severe postoperative complications and lower stoma reversal rates with this procedure.