scholarly journals Is it possible to restore digestive continuity in all patients after a Hartmann procedure? Multicentric retrospective experience in 360 consecutive patients

2022 ◽  
Vol 5 ◽  
pp. 100036
Author(s):  
Chavrier Daphné ◽  
Bouiller Mathilde ◽  
Lebreton Gil ◽  
Abdelli Amar ◽  
Chautard Julien ◽  
...  
Keyword(s):  
Hartmann Procedure

scholarly journals Reversión operación de Hartmann por vía laparoscópica

2021 ◽  
Author(s):  
Marcelo Viola Malet
Keyword(s):  
Multicenter Study ◽  
Open Surgery ◽  
Hartmann’S Procedure ◽  
Efficacy And Safety ◽  
Hartmann Procedure ◽  
Free Survival ◽  
Hartmann’S Reversal ◽  
Hartmann's Procedure ◽  
Colostomy Reversal ◽  
Hartmann's Reversal

Introducción. El procedimiento de Hartmann es una de las cirugías que se realizan con mayor frecuencia frente a una complicación oclusiva o perforativa de colon izquierdo; nos permite resolver el cuadro clínico de la complicación. El porcentaje de restitución del tránsito intestinal es muy bajo, promedialmente inferior al 50%. Ésto se debe a factores propios del paciente, la morbimortalidad de la cirugía, y a dificultades técnicas. El reestablecimiento del tránsito intestinal luego de un Hartmann puede llegar a ser una cirugía muy hostil. Tiene una morbilidadmortalidad propia no despreciable, independientemente de la vía de abordaje utilizada. La reversión por laparoscopía es uno de los procedimientos más complejos a realizar mediante este abordaje. Pero varios estudios han demostrado, que si bien requiere de una curva de aprendizaje más larga y un nivel de destreza técnica alto, tiene mejores resultados que el laparotómico.   Descripción. Presentamos el caso clínico de un hombre de 65 años, que consultó por una peritonitis purulenta diverticular un año atrás, al cual se le realizó una procedimiento de Hartmann. Se coordina para reconstrucción del tránsito intestinal por vía laparoscópica. Paciente en decúbito dorsal, Trendelemburg 30º y lateralizado a derecha. Neumoperitoneo hasta 12mmHg por técnica abierta en flanco derecho para un puerto de 12mm, inicialmente para la cámara, y luego para la mano izquierda del cirujano. Otro de 6mm en fosa ilíaca derecha para la mano derecha del cirujano, y  uno de 12mm supraumbilical para la cámara. Identificamos el muñón rectal en la pelvis. Liberamos el ostoma circunferencialmente, y confeccionamos una jareta con polipropileno 2-0. Colocacamos el anvil de la sutura mecánica 29mm, y reintroducimos el cabo colónico al abdomen. Se realiza cierre parietal en dos planos, y reinstalamos el neumoperitoneo. Colocacamos la sutura mecánica transrectal, engarzando la misma con el anvil a través de la cara anterior del muñón rectal, confeccionando la anastomosis colo-rectal término-lateral. La prueba hidroneumática fue negativa. El paciente tuvo un postoperatorio sin complicaciones, otorgándole el alta a las 72hs del procedimiento, tolerando vía oral, sin dolor, sin fiebre y habiendo movilizado el intestino.   Conclusiones. La cirugía de Hartmann sigue siendo uno de los procedimiento más realizados para tratar las complicaciones perforativas y oclusivas del colon izquierdo y recto. La restitución del tránsito intestinal luego de esta cirugía tiene un altísimo porcentaje de no concretarse por diferentes motivos. La cirugía miniinvasiva requiere de una larga curva de aprendizaje y destreza de alto nivel, pero hay varios trabajos que demuestran que la reversión de un Hartmann tiene mejores resultados por esta vía.   Bibliografía Hallam S, Mothe BS, Tirumulaju R. Hartmann's procedure, reversal and rate of stoma-free survival. Ann R Coll Surg Engl. 2018;100(4):301-307. doi:10.1308/rcsann.2018.0006 Horesh N, Lessing Y, Rudnicki Y, et al. Considerations for Hartmann's reversal and Hartmann's reversal outcomes-a multicenter study. Int J Colorectal Dis. 2017;32(11):1577-1582. doi:10.1007/s00384-017-2897-2 Melkonian E, Heine C, Contreras D, et al. Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery. J Minim Access Surg. 2017;13(1):47-50. doi:10.4103/0972-9941.181329 Resio BJ, Jean R, Chiu AS, Pei KY. Association of Timing of Colostomy Reversal With Outcomes Following Hartmann Procedure for Diverticulitis. JAMA Surg. 2019;154(3):218-224. doi:10.1001/jamasurg.2018.4359 Park W, Park WC, Kim KY, Lee SY. Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal. Ann Coloproctol. 2018;34(6):306-311. doi:10.3393/ac.2018.09.07

scholarly journals First thousand rectal cancer cases: Local recurrence and survival

2004 ◽  
Vol 51 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Zoran Krivokapic ◽  
Goran Barisic ◽  
V. Markovic ◽  
Milos Popovic ◽  
Sladjan Antic ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Anal Verge ◽  
Preoperative Staging ◽  
Recurrence Rates ◽  
Hartmann Procedure ◽  
Cumulative Survival ◽  
Colorectal Anastomoses ◽  
Significant Difference ◽  
Dukes C

In the period 1990 - 2002, 1674 patients with colorectal carcinoma were operated in the First Surgical Clinic, Third Department for Colorectal Surgery. In 1264 cases (75,5%) rectal carcinoma was the indication for surgical treatment. Sphincter saving procedures (SSP) were performed in 824 (65,2%), abdominoperineal resections (APR) in 340 (26,9%) and resections of rectum with definitive stoma (Hartmann procedure) in 100 (7,9%) patients. We analyzed 1095 cases where curative SSP or APR were performed. All cases where curative resection was not possible because of liver metastases or inability to excise all macroscopic disease were excluded. In the group of patients where SSP was performed (767 cases), there were 26,6% high colorectal anastomoses (8cm from anal verge), 65,4% with low (4-8cm from anal verge) and 8,0% with intersphincteric coloanal anastomosis (cm from anal verge). Patohistological exam showed 5,3% Dukes A, 53,1% Dukes B, 36,5% Dukes C and 4,9% Dukes D. In the APR group (328 cases) there were 1,5% Dukes A, 32,4% Dukes B, 62,1% Dukes C and 3,5% Dukes D. In this study we analyzed local recurrence and five-year survival in both groups. Recurrence of the disease was registered in 325 (29,6%) out of 1095 patients. Local recurrence was found in 81 (7,4%) patients. In the SSP group recurrence occured in 215 (28,0%) out of 767 curative resections. Local recurrence alone was found in 53 patients (6,9%). SSP group was also divided into two subgroups; in the first group TME was performed and in second transection of mesorectum was carried out. Analyzing local recurrence in these two groups, in the TME group it was 7,6% and in the transection group 5,6%. In the APR group recurrence was registered in 110 (33,5%) out of 328 patients while local recurrence alone was found in 28 (8,5%) cases. Analyzing mortality we found that 234 (21,4%) out of 1095 patients died during follow-up. In the SSP group 154 out of 767 patients (20,1%) died. In the TME group mortality was 21,7% and in the transection group 16,9%. Mortality in the APR group showed that 80 out of 328 (24,4%) patients died during follow-up. Analysis by the Kaplan-Meier?s test shows cumulative survival of 0,69 for all cases. In the SSP group cumulative survival is 0,72 and in the APR group 0,64 with statistically significant difference (p,001). In the TME group cumulative survival is 0,75 and in the transection group 0,72 with statistically significant difference (p,05). We believe that performing SSP should be encouraged whenever it is possible because there is no difference in local recurrence rates and survival compared to APR. Transection of mesorectum can safely be performed in most cases with tumors located more than 8 cm form anal verge. We believe that exact preoperative staging and preoperative radiotherapy could improve results.

scholarly journals P074 PARASTOMAL AND INCISIONAL HERNIAS FOLLOWING EMERGENCY SURGERY FOR HINCHEY III-IV DIVERTICULITIS: A SYSTEMATIC REVIEW

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Elisa Mäkäräinen ◽  
Tero Rautio ◽  
Filip Muysoms ◽  
Joonas Kauppila
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Incisional Hernia ◽  
Parastomal Hernia ◽  
Primary Anastomosis ◽  
Controlled Trials ◽  
Hartmann Procedure ◽  
Randomized Controlled ◽  
Hernia Incidence

Abstract Aim The aim of this systematic review was to report the risk of parastomal and incisional hernias after emergency surgery for Hinchey III–IV diverticulitis. Material and Methods The Cochrane Library, Embase, PubMed (MEDLINE), Web of Science and Scopus databases were systematically searched. All randomized controlled trials (RCTs) and cohort studies comparing HP with other surgical treatment options for perforated diverticulitis classified as purulent or faecal (Hinchey III–IV) were considered for inclusion. Exclusion criteria were case series and reports, letters, editorials, reviews and conference abstracts. The primary endpoint was parastomal hernia incidence. The secondary endpoint was incisional hernia incidence. Seven studies (six randomized controlled trials and one retrospective cohort) with a total of 831 patients were eligible for inclusion. Results The parastomal hernia incidence was 15.2–46.0% for Hartmann procedure, 0–85.2% for primary anastomosis, 4.3% for resection and 1.6 % for laparoscopic lavage. The incisional hernia incidences were 7.8–38.1% for Hartmann procedure, 4.5–27.2% for primary anastomosis, 3.2–25.5% for primary resection, 2.7–11.1% for laparoscopic lavage and 16.1–45.8% for secondary resection. Due to heterogeneity of follow-up methods, follow-up time and lack of both parastomal and incisional hernia as outcome, no meta-analysis was conducted. Conclusions The hernia incidences reported after surgical treatment for complicated diverticulitis may be biased and underestimated. For future RCTs, researchers are encouraged to pay attention to hernia diagnosis, symptoms and prevention.

Standardization of laparoscopic reversal of the Hartmann procedure: A single‐center report

2020 ◽  
Author(s):  
Daisuke Yamamoto ◽  
Yusuke Sakimura ◽  
Hirotaka Kitamura ◽  
Toshikatsu Tsuji ◽  
Shinichi Kadoya ◽  
...  
Keyword(s):  
Single Center ◽  
Hartmann Procedure ◽  
Center Report

scholarly journals Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 269 ◽  
Author(s):  
Georgi Popivanov ◽  
Piergiorgio Fedeli ◽  
Roberto Cirocchi ◽  
Massimo Lancia ◽  
Domenico Mascagni ◽  
...  
Keyword(s):  
Rectal Bleeding ◽  
Rectal Wall ◽  
Original Data ◽  
Operative Management ◽  
Stapled Hemorrhoidopexy ◽  
Current Evidence ◽  
Transanal Surgery ◽  
Hartmann Procedure ◽  
Ct Guided ◽  
Abdominal Bleeding

Background and Objectives: The present study aims to assess the effectiveness and current evidence of the treatment of perirectal bleeding after stapled haemorrhoidopexy. Materials and methods: A systematic literature review was performed that combined the published and the obtained original data after a search of PubMed, Web of Science, and SCOPUS. Results: The present systematic review includes 16 articles with 37 patients. Twelve papers report perirectal and six report intra-abdominal bleeding. Stapled hemorrhoidopexy (SH) was performed in 57% of cases (3 PPH 01 and 15 PPH 03), stapled transanal rectal resection (STARR) in 13%, and for 30% information was not available. The median age was 49 years (±11.43). The sign and symptoms of perirectal bleeding were abdominal pain (43%), pelvic discomfort without rectal bleeding (36%), urinary retention (14%), and external rectal bleeding (21%). The median time to bleeding was 1 day (±1.53 postoperative days), with median hemoglobin at diagnosis 8.8 ± 1.04 g/dL. Unstable hemodynamic was reported in 19%. Computed tomography scan (CT) was the first examination in 77%. Only two cases underwent the abdominal US, but subsequently, a CT scan was also conducted. Non-operative management was performed in 38% (n = 14) with selective arteriography and percutaneous angioembolization in two cases. A surgical treatment was performed in 23 cases—transabdominal surgery (3 colostomies, 1 Hartmann’ procedure, 1 low anterior resection of the rectum, 1 bilateral ligation of internal iliac artery and 1 ligation of vessels located at the rectal wall), transanal surgery (n = 13), a perineal incision in one, and CT-guided paracoccygeal drainage in one. Conclusions: Because of the rarity and lack of experience, no uniform tactic for the treatment of perirectal hematomas exists in the literature. We propose an algorithm similar to the approach in pelvic trauma, based on two main pillars—hemodynamic stability and the finding of contrast CT.

scholarly journals THE VULKAN TECHNIQUE: A NOVEL OSTOMY-CLOSURE TECHNIQUE THAT REDUCES COMPLICATIONS AND OPERATIVE TIMES

2017 ◽  
Vol 30 (2) ◽  
pp. 139-142 ◽  
Author(s):  
Felix KRENZIEN ◽  
Christian BENZING ◽  
Fabian HARDERS ◽  
Tido JUNGHANS ◽  
Gyurdhan RASIM ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Surgical Complications ◽  
Subcutaneous Tissue ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Skin Incision ◽  
Colostomy Closure ◽  
Hartmann Procedure ◽  
Prolonged Hospital

ABSTRACT Background: Ostomy reversals remain at high risk for surgical complications. Indeed, surgical-side infections due to bacterial contamination of the stoma lead to revision surgery and prolonged hospital stay. Aim: To describe the novel vulkan technique of ostomy reversal that aims to reduce operative times, surgical complications, and readmission rates. Methods: Ostomy closure was performed using the vulkan technique in all patients. This technique consists of external intestinal closure, circular skin incision and adhesiolysis, re-anastomosis, and closure of the subcutaneous tissue in three layers, while leaving a small secondary wound through which exudative fluid can be drained. The medical records of enterostomy patients were retrospectively reviewed from our hospital database. Results: The vulkan technique was successfully performed in 35 patients mainly by resident surgeons with <5 years of experience (n=22; 62.8%). The ileostomy and colostomy closure times were 53 min (interquartile range [IQR], 41-68 min; n=22) and 136 min (IQR: 88-188 min; n=13; p<0.001), respectively. The median hospital stay was seven days (IQR: 5−14.5 days); the length of hospital stay did not differ between ileostomy and colostomy groups. Major surgical complications occurred only in patients who underwent colostomy closure following the Hartmann procedure (n=2); grade≥IIIb according Clavien-Dindo classification. Conclusion: The vulkan technique was successfully applied in all patients with very low rates of surgical-site infections. Off note, residents with limited surgical experience mainly performed the procedure while operating time was less than one hour.

Hartmann’s pouch, the Hartmann operation, the Hartmann procedure

1996 ◽  
Vol 10 (1) ◽  
pp. 81-82 ◽  
Author(s):  
E. F. DeMaio ◽  
C. Naranjo ◽  
P. Johnson
Keyword(s):  
Hartmann Procedure ◽  
Hartmann Operation

scholarly journals Fulminant Shigellosis in a HIV Patient

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Siang Mei Sally Ooi
Keyword(s):  
Rare Case ◽  
Wall Thickening ◽  
Immunosuppressed Patient ◽  
Hartmann Procedure ◽  
Pneumatosis Coli ◽  
Colonic Wall ◽  
Intravenous Antibiotics ◽  
Infectious Enterocolitis

Infectious enterocolitis caused byshigellais usually self-limiting and seldom requires antibiotics treatment. It is uncommon to develop fulminant shigellosis requiring surgery. We report a rare case of fulminant shigellosis in a HIV patient with recurring infection which could not be managed with intravenous antibiotics. CT reviewed extensive colonic wall thickening and stranding with evidence of pneumatosis coli. The patient eventually required a Hartmann procedure. Although fulminant shigellosis is uncommon, thorough assessment and vigilant management are warranted in immunosuppressed patient.

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