Validity of the Hartmann operation in the treatment of complicated colonic diverticulosis: study carried out in patients treated during the period 2009-2018, at Hospital de Clínicas, Montevideo
DOI:
https://doi.org/10.31837/cir.urug.5.2.3Keywords:
colonic diverticulosis, Hartmann's operation, Hinchey's classification, colostomy, reconstructionAbstract
Introduction and objectives: Complicated diverticular disease is a health problem that affects elderly patients and often requires surgical treatment. Options are multiple, being Hartmann procedure an old and still valid alternative. The objective of the present study was to evaluate the validity of this procedure in our environment through an analytical study of a population in a University Hospital of Montevideo.
Materials and methods: Analyze the medical records of patients older than 20 years operated on in the period 2009-2018. Consider the following variables: surgical procedures, peri-operative complications, re-treatments, rate and time of reconstruction of the digestive transit and mortality.
Results: 27 patients were operated in the analyzed period, with a mean age of 59.4 years. In 15 of them, a Hartmann procedure was performed. In the remaining patients, procedures performed were approach both ends, primary anastomosis with or without a proximal stoma, and assisted video washing and drainage without resection. Eleven patients (40%) presented peri-operative complications. Peri-operative mortality was four patients (14.8%), all corresponding to Hartmann's operation. The recovery rate was six of 11 surviving patients.
Discussion: The Hartmann operation maintains the validity and the most used procedure, being its considerable morbidity and mortality and the recovery rate of approximately half of the patients. The primary anastomosis should be reserved for selected cases. The development of laparoscopic surgery has also allowed conservative procedures, such as washing and drainage, avoiding acute resection, this option being a growing trend.
Conclusions: It was concluded that the series, although short, reproduce what was reviewed in the bibliography.
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References
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2. García-osogobio JMCS. Sigmoidectomía con anastomosis primaria para diverticulitis complicada. Rev Gastroenterol México [Internet]. 2015;80(4):255–9. http://dx.doi.org/10.1016/j.rgmx.2015.07.005
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6. Ambrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management – a prospective study of 542 patients. Eur Radiol. 2002; 12:1145–1149 doi: 10.1007/s00330-001-1143-y
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8. Cirocchi R, Afshar S, Di Saverio S, Popivanov G, De Sol A, Gubbiotti F, Tugnoli G , et al. A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart-Mummery to evidence-based medicine. World Jour Em Surg 2017; 14: 1-25. Doi: 10.1186/s13017-017-0120-y
9. Halim H, Askari A, Nunn R, Hollingshead H. Primary resection anastomosis versus Hartmann’s procedure in Hinchey III and IV diverticulitis. World Jour Em Surg 2019; 32: 4-11. doi: 10.1186/s13017-019-0251-4.
10. Charúa-Guindic L, Jiménez-Bobadilla B, Reveles-González A, Avendaño-Espinosa O, Charúa-Levy E. Incidencia, diagnóstico y tratamiento de la fístula colovesical. Cir Cir 2007;7575(5):343–9. Disponible en: http://www.medigraphic.com/pdfs/circir/cc-2007/cc075e.pdf
11. Resio BJ, Jean R, Chiu AS, Pei KY. Association of Timing of Colostomy Reversal With Outcomes. JAMA Surg. 2019; 154 (3): 218-224. doi: 10.1001 / jamasurg.2018.4359
12. Javier F, Fernández M, Jiménez ND, Belén A, Herrera G, Luque IG, Garcilazo Arsimendi DJ, Gómez Barbadillo J. Nuevas tendencias en el manejo de la diverticulitis y la enfermedad diverticular del colon. Rev Esp Enf Dig 2015; 107:162–70
13. Dindo D, Demartines N, Clavien P-A. Classification of Surgical Complications. A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surg 2004; 240(2): 205-13. doi: 10.1097/01.sla.0000133083.54934.ae
14. Clavien P-A, Barkun J, L de Oliveira M, Vauthey JN, Dindo D, Schulick R, de Santibañes E, et al. The Clavien-Dindo Classification of Surgical Complications. Five-Year Experience. Ann Surg 2009; 250(2): 187-96. doi: 10.1097/SLA.0b013e3181b13ca2
15. Hall J, Hardiman K, Lee S, Lightner A, Stocchi L, Paquette I, Steele S, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Dis Colon Rectum 2020; 63: 728–747.doi:10.1097/DCR.0000000000001679
16. Wieghard N, Geltzeiler CB, Tsikitis VL. Trends in the surgical management of diverticulitis. Ann Gastroenterol. 2015;28(1):25–30
DOI: 10.31837/cir.urug/5.2.3 Cir. Urug. 2021 Vol. 5 No. 2 jul – dic 2021 1-17
17. Lambrichts DP, Birindelli A, Tonini V, Cirocchi R, Cervellera M, Lange JF, Bemelman W, et al. The Multidisciplinary Management of Acute Complicated Diverticulitis. Inflam Intest Diseases 2018; 3: 80–90. doi: 10.1159/000486677
18. Deery SE, Hodin RA. Management of diverticulitis in 2017. J Gastrointest Surg. 2017; 21:1732–1741. doi: 10.1007/s11605-017-3404-3
19. Thornell A, Angenete E, Gonzales E, Heath J, Jess P, Läckberg Z, Ovesen H, et al. Treatment of acute diverticulitis laparoscopic lavage vs. resection (DILALA): study protocol for a randomised controlled trial Treatment of acute diverticulitis laparoscopic a randomised controlled trial. Trials 2011;186:1–6. doi: 10.1186/1745-6215-12-186
20. Ceresoli M, Coccolini F, Montori G, Catena F, Sartelli M, Ansaloni L. Laparoscopic lavage versus resection in perforated diverticulitis with purulent peritonitis: a metaanalysis of randomized controlled trials. World Journ Em Surg 2016; 42: 1–8. doi: 10.1186/s13017-016-0103-4
21. Vennix S, Musters G, Mulder I, Swank H, Consten E, Belgers E, van Geloven A, et al. Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial. Lancet. 2015; 386:1269–77. Doi: 10.1016/S0140-6736(15)61168-0
22. Lambrichts DPV, Bolkenstein HE, van der Does DCHE, Dieleman D, Crolla R M P H, Dekker J W T, van Duijvendijk P, et al. Multicentre study of non-surgical management of diverticulitis with abscess formation. Br J Surg. 2019; 106:458–466 doi: 10.1002/bjs.11129
23. Santander C, Astudillo P, Manterola C. Procedimiento de Hartmann vs resección y anastomosis primaria en peritonitis diverticular de colon izquierdo por cirugía abierta. Revisión sistemática de la literatura. Rev Chil Cir 2013;65:271–8 doi: 10.4067/S0718-40262013000300014
24. Garber A, Hyman N, Osler T. Complications of Hartmann takedown in a decade of preferred primary anastomosis. Am J Surg [Internet] 2014;207(1):60–4. Doi: 10.1016/j.amjsurg.2013.05.006
25. Hupfeld L, Burcharth J, Pommergaard H, Rosenberg J. The Best Choice of Treatment for Acute Colonic Diverticulitis with Purulent Peritonitis Is Uncertain. BioMed Research International 2014: 1-5 Article ID 380607. Doi: 10.1155/2014/380607
26. Biondo S, Borao JL, Millan M, Kreisler E et al. Current status of the treatment of acute colonic diverticulitis: a systematic review. Colorectal Dis 2011; 14(1): 1–11. Doi: 10.1111/j.1463-1318.2011.02766.x
27. Bridoux V, Regimbeau JM, Ouaissi M, Mathonnet M, Mauvais F, Houivet E, Schwarz L, Mege D, et al. Hartmann’s procedure or primary anastomosis for generalized peritonitis due to perforated diverticulitis: a prospective multicenter randomized trial (DIVERTI). J Am Coll Surg. 2017; 225:798–805. doi: 10.1016/j.jamcollsurg.2017.09.004
28. Gachabayov M, Oberkofler CE, Tuech JJ, Hahnloser D, Bergamaschi R. Resection with primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a systematic review and meta-analysis. Colorectal Dis. 2018; 20:753–770. doi: 10.1111/codi.14237
DOI: 10.31837/cir.urug/5.2.3 Cir. Urug. 2021 Vol. 5 No. 2 jul – dic 2021 1-17
29. Acuna SA, Dossa F, Baxter NN. The end of the Hartmann’s era for perforated diverticulitis. Lancet Gastroenterol Hepatol. 2019; 4:573–575. doi: 10.1016/S2468-1253(19)30182-7
30. Lee JM, Bai P Chang J, El Hechi M, Kongkaewpaisan N, Bonde A, Mendoza A, Saillant N, et al. Hartmann’s procedure vs primary anastomosis with diverting loop ileostomy for acute diverticulitis: nationwide analysis of 2,729 emergency surgery patients. J Am Coll Surg. 2019; 229:48–55. doi: 10.1016/j.jamcollsurg.2019.03.007 31. Moro-Valdezate D, Royo-Aznar A, Martín-Arévalo J, Pla-martí V, García-Botello S, Espinoza SL Fernández-Moreno MC et al. Outcomes of Hartmann’ s procedure and subsequent intestinal restoration. Which patients are most likely to undergo reversal? Am Journ Surg 2019(11), 218(5): 918-27. DOI: 10.1016/j.amjsurg.2019.02.025
32. Roig V, Salvador A, Frasson M, García L, Espinosa J, Roselló V, Hernandis J et al. Stoma Reversal After Surgery for Complicated Acute Diverticulitis: A Multicentre Retrospective. Cir Esp 2018; 6:2–10 doi: /10.1016/j.cireng.2018.02.012
33. Sherman KL, Wexner SD, Ed F. Considerations in Stoma Reversal. Clinics in Colon and Rectal Surgery 2017; 172–7. doi: 10.1055/s-0037-1598157
34. Sciuto P, Rappa J, Meineri J, Ruso L et al. Restitución del procedimiento de Hartmann por vía laparoscópica. Análisis de nuestra experiencia en el Hospital Maciel de Montevideo, Uruguay, Clínicas Quirúrgicas 2 y 3 de la Facultad de Medicina de la Universidad de la República (UDELAR). Rev Chil Cir 2017;69(6): 446-51. Doi: 10.1016/j.rchic.2017.06.001
35. Rosenthal R, Kettelhack C, Oertli D. Reversal after Hartmann’s procedure in patients with complicated sigmoid diverticulitis. Colorectal Dis 2016; 19(6): 582–8 doi: 10.1111/codi.13553
36. Aquina CT, Probst CP, Becerra AZ. Colon / rectum The impact of surgeon volume on colostomy reversal outcomes after Hartmann’ s procedure for diverticulitis. Surgery [Internet].2016;160(5):1309–17. Doi: 10.1016/j.surg.2016.05.008
37. Hallam S, Mothe BS, Tirumulaju RMR. Hartmann’s procedure , reversal and rate of stoma-free survival. Ann R Coll Surg Engl 2018; 100: 301–7 doi 10.1308/rcsann.2018.0006
38. Zarnescu EC, Zarnescu NO, Costea R, Rahau L, Neagu S. Morbidity after reversal of Hartmann operation: retrospective analysis of 56 patients. J Med Life 2015;8(4):488–91
2. García-osogobio JMCS. Sigmoidectomía con anastomosis primaria para diverticulitis complicada. Rev Gastroenterol México [Internet]. 2015;80(4):255–9. http://dx.doi.org/10.1016/j.rgmx.2015.07.005
3. Chabok A, Pahlman L, Hiern F, Haapaniemi S Smedh K, AVOD study group. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012; 99:532–9.
4. Daniels L, Unlu C, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, Consten EC, et al. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg. 2017; 104:52–61.DOI: 10.31837/cir.urug/5.2.3 Cir. Urug. 2021 Vol. 5 No. 2 jul – dic 2021 1-17
5. Ambrosetti P. Acute diverticulitis of the left colon: value of the initial CT and timing of elective colectomy. J Gastrointest Surg.2008;12:1318–1320. doi: 10.1007/s11605-008-0489-8
6. Ambrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management – a prospective study of 542 patients. Eur Radiol. 2002; 12:1145–1149 doi: 10.1007/s00330-001-1143-y
7. Rosado R, Blasco T, Ferrer M, Marín H, Pérez-Domínguez L, Biondo S, Roig-Vila JV. Enfermedad diverticular complicada: toma de posición sobre tratamiento ambulatorio, intervención de Hartmann, lavado-drenaje peritoneal y cirugía laparoscópica. Documento de consenso de la Asociación Española de Coloproctología y Sección de Coloproctología de la Asociación Española de Cirujanos. Cir Esp 2017; 95(7): 369-77. doi: 10.1016/j.ciresp.2017.03.008
8. Cirocchi R, Afshar S, Di Saverio S, Popivanov G, De Sol A, Gubbiotti F, Tugnoli G , et al. A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart-Mummery to evidence-based medicine. World Jour Em Surg 2017; 14: 1-25. Doi: 10.1186/s13017-017-0120-y
9. Halim H, Askari A, Nunn R, Hollingshead H. Primary resection anastomosis versus Hartmann’s procedure in Hinchey III and IV diverticulitis. World Jour Em Surg 2019; 32: 4-11. doi: 10.1186/s13017-019-0251-4.
10. Charúa-Guindic L, Jiménez-Bobadilla B, Reveles-González A, Avendaño-Espinosa O, Charúa-Levy E. Incidencia, diagnóstico y tratamiento de la fístula colovesical. Cir Cir 2007;7575(5):343–9. Disponible en: http://www.medigraphic.com/pdfs/circir/cc-2007/cc075e.pdf
11. Resio BJ, Jean R, Chiu AS, Pei KY. Association of Timing of Colostomy Reversal With Outcomes. JAMA Surg. 2019; 154 (3): 218-224. doi: 10.1001 / jamasurg.2018.4359
12. Javier F, Fernández M, Jiménez ND, Belén A, Herrera G, Luque IG, Garcilazo Arsimendi DJ, Gómez Barbadillo J. Nuevas tendencias en el manejo de la diverticulitis y la enfermedad diverticular del colon. Rev Esp Enf Dig 2015; 107:162–70
13. Dindo D, Demartines N, Clavien P-A. Classification of Surgical Complications. A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surg 2004; 240(2): 205-13. doi: 10.1097/01.sla.0000133083.54934.ae
14. Clavien P-A, Barkun J, L de Oliveira M, Vauthey JN, Dindo D, Schulick R, de Santibañes E, et al. The Clavien-Dindo Classification of Surgical Complications. Five-Year Experience. Ann Surg 2009; 250(2): 187-96. doi: 10.1097/SLA.0b013e3181b13ca2
15. Hall J, Hardiman K, Lee S, Lightner A, Stocchi L, Paquette I, Steele S, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Dis Colon Rectum 2020; 63: 728–747.doi:10.1097/DCR.0000000000001679
16. Wieghard N, Geltzeiler CB, Tsikitis VL. Trends in the surgical management of diverticulitis. Ann Gastroenterol. 2015;28(1):25–30
DOI: 10.31837/cir.urug/5.2.3 Cir. Urug. 2021 Vol. 5 No. 2 jul – dic 2021 1-17
17. Lambrichts DP, Birindelli A, Tonini V, Cirocchi R, Cervellera M, Lange JF, Bemelman W, et al. The Multidisciplinary Management of Acute Complicated Diverticulitis. Inflam Intest Diseases 2018; 3: 80–90. doi: 10.1159/000486677
18. Deery SE, Hodin RA. Management of diverticulitis in 2017. J Gastrointest Surg. 2017; 21:1732–1741. doi: 10.1007/s11605-017-3404-3
19. Thornell A, Angenete E, Gonzales E, Heath J, Jess P, Läckberg Z, Ovesen H, et al. Treatment of acute diverticulitis laparoscopic lavage vs. resection (DILALA): study protocol for a randomised controlled trial Treatment of acute diverticulitis laparoscopic a randomised controlled trial. Trials 2011;186:1–6. doi: 10.1186/1745-6215-12-186
20. Ceresoli M, Coccolini F, Montori G, Catena F, Sartelli M, Ansaloni L. Laparoscopic lavage versus resection in perforated diverticulitis with purulent peritonitis: a metaanalysis of randomized controlled trials. World Journ Em Surg 2016; 42: 1–8. doi: 10.1186/s13017-016-0103-4
21. Vennix S, Musters G, Mulder I, Swank H, Consten E, Belgers E, van Geloven A, et al. Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial. Lancet. 2015; 386:1269–77. Doi: 10.1016/S0140-6736(15)61168-0
22. Lambrichts DPV, Bolkenstein HE, van der Does DCHE, Dieleman D, Crolla R M P H, Dekker J W T, van Duijvendijk P, et al. Multicentre study of non-surgical management of diverticulitis with abscess formation. Br J Surg. 2019; 106:458–466 doi: 10.1002/bjs.11129
23. Santander C, Astudillo P, Manterola C. Procedimiento de Hartmann vs resección y anastomosis primaria en peritonitis diverticular de colon izquierdo por cirugía abierta. Revisión sistemática de la literatura. Rev Chil Cir 2013;65:271–8 doi: 10.4067/S0718-40262013000300014
24. Garber A, Hyman N, Osler T. Complications of Hartmann takedown in a decade of preferred primary anastomosis. Am J Surg [Internet] 2014;207(1):60–4. Doi: 10.1016/j.amjsurg.2013.05.006
25. Hupfeld L, Burcharth J, Pommergaard H, Rosenberg J. The Best Choice of Treatment for Acute Colonic Diverticulitis with Purulent Peritonitis Is Uncertain. BioMed Research International 2014: 1-5 Article ID 380607. Doi: 10.1155/2014/380607
26. Biondo S, Borao JL, Millan M, Kreisler E et al. Current status of the treatment of acute colonic diverticulitis: a systematic review. Colorectal Dis 2011; 14(1): 1–11. Doi: 10.1111/j.1463-1318.2011.02766.x
27. Bridoux V, Regimbeau JM, Ouaissi M, Mathonnet M, Mauvais F, Houivet E, Schwarz L, Mege D, et al. Hartmann’s procedure or primary anastomosis for generalized peritonitis due to perforated diverticulitis: a prospective multicenter randomized trial (DIVERTI). J Am Coll Surg. 2017; 225:798–805. doi: 10.1016/j.jamcollsurg.2017.09.004
28. Gachabayov M, Oberkofler CE, Tuech JJ, Hahnloser D, Bergamaschi R. Resection with primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a systematic review and meta-analysis. Colorectal Dis. 2018; 20:753–770. doi: 10.1111/codi.14237
DOI: 10.31837/cir.urug/5.2.3 Cir. Urug. 2021 Vol. 5 No. 2 jul – dic 2021 1-17
29. Acuna SA, Dossa F, Baxter NN. The end of the Hartmann’s era for perforated diverticulitis. Lancet Gastroenterol Hepatol. 2019; 4:573–575. doi: 10.1016/S2468-1253(19)30182-7
30. Lee JM, Bai P Chang J, El Hechi M, Kongkaewpaisan N, Bonde A, Mendoza A, Saillant N, et al. Hartmann’s procedure vs primary anastomosis with diverting loop ileostomy for acute diverticulitis: nationwide analysis of 2,729 emergency surgery patients. J Am Coll Surg. 2019; 229:48–55. doi: 10.1016/j.jamcollsurg.2019.03.007 31. Moro-Valdezate D, Royo-Aznar A, Martín-Arévalo J, Pla-martí V, García-Botello S, Espinoza SL Fernández-Moreno MC et al. Outcomes of Hartmann’ s procedure and subsequent intestinal restoration. Which patients are most likely to undergo reversal? Am Journ Surg 2019(11), 218(5): 918-27. DOI: 10.1016/j.amjsurg.2019.02.025
32. Roig V, Salvador A, Frasson M, García L, Espinosa J, Roselló V, Hernandis J et al. Stoma Reversal After Surgery for Complicated Acute Diverticulitis: A Multicentre Retrospective. Cir Esp 2018; 6:2–10 doi: /10.1016/j.cireng.2018.02.012
33. Sherman KL, Wexner SD, Ed F. Considerations in Stoma Reversal. Clinics in Colon and Rectal Surgery 2017; 172–7. doi: 10.1055/s-0037-1598157
34. Sciuto P, Rappa J, Meineri J, Ruso L et al. Restitución del procedimiento de Hartmann por vía laparoscópica. Análisis de nuestra experiencia en el Hospital Maciel de Montevideo, Uruguay, Clínicas Quirúrgicas 2 y 3 de la Facultad de Medicina de la Universidad de la República (UDELAR). Rev Chil Cir 2017;69(6): 446-51. Doi: 10.1016/j.rchic.2017.06.001
35. Rosenthal R, Kettelhack C, Oertli D. Reversal after Hartmann’s procedure in patients with complicated sigmoid diverticulitis. Colorectal Dis 2016; 19(6): 582–8 doi: 10.1111/codi.13553
36. Aquina CT, Probst CP, Becerra AZ. Colon / rectum The impact of surgeon volume on colostomy reversal outcomes after Hartmann’ s procedure for diverticulitis. Surgery [Internet].2016;160(5):1309–17. Doi: 10.1016/j.surg.2016.05.008
37. Hallam S, Mothe BS, Tirumulaju RMR. Hartmann’s procedure , reversal and rate of stoma-free survival. Ann R Coll Surg Engl 2018; 100: 301–7 doi 10.1308/rcsann.2018.0006
38. Zarnescu EC, Zarnescu NO, Costea R, Rahau L, Neagu S. Morbidity after reversal of Hartmann operation: retrospective analysis of 56 patients. J Med Life 2015;8(4):488–91
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2021-03-24
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Barberousse C, Ramírez L, Dardanelli S, Fernández L. Validity of the Hartmann operation in the treatment of complicated colonic diverticulosis: study carried out in patients treated during the period 2009-2018, at Hospital de Clínicas, Montevideo. Cir. Urug. [Internet]. 2021 Mar. 24 [cited 2026 Jun. 11];5(2):1-17. Available from: https://replica-revista.scu.org.uy/index.php/cir_urug/article/view/3264
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