Routine evaluation of the distal colon remnant before Hartmann's reversal is not necessary in asymptomatic patients

Academic Article

Abstract

  • Background: Reversal of Hartmann's is a common surgical procedure. Routine preoperative evaluation of the distal colonic/rectal remnant (DCRR) with contrast and/or endoscopic studies is frequently performed despite lack of evidence to support this practice. We hypothesize that asymptomatic patients can safely undergo Hartmann's reversal without preoperative DCRR evaluation. Methods: Adult patients undergoing reversal of Hartmann's at a single institution were retrospectively identified. Operative characteristics and outcomes in patients with and without preoperative DCRR evaluation were compared. Results: Between 1993 and 2008, 203 patients underwent reversal of Hartmann's at a tertiary referral center. Sixty-eight patients (33%) did not undergo preoperative DCRR evaluation and had comparable demographic characteristics, comorbidities, DCRR length, and perioperative outcomes to 135 patients who underwent preoperative contrast and/or endoscopic studies. After evaluation, 125 (93%) patients had normal findings, seven (5%) patients had abnormal studies that did not impact their management, and three (2%) patients underwent additional procedures. Conclusion: Hartmann's reversal without previous DCRR evaluation is acceptable in selected asymptomatic patients, without increased risk of complications. © 2009 The Society for Surgery of the Alimentary Tract.
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    Digital Object Identifier (doi)

    Author List

  • Ballian N; Zarebczan B; Munoz A; Harms B; Heise CP; Foley EF; Kennedy GD
  • Start Page

  • 2260
  • End Page

  • 2267
  • Volume

  • 13
  • Issue

  • 12