EVOLUTION OF HARTMANN INTERVENTION - 249 INTERVENTIONS

A retrospective study of 249 patients undergoing Hartmann's procedure over twenty-five years was undertaken to analyse the evolution of indi cations and results. Patients were divided into three time period grou ps : from 1969 to 1978, 1979 to 1990 and 1991 to 1994. Mean age was 68 years old. Major indications were complicated diverticular disease (4 2,9 %), colo-rectal malignancies (35,7 %) and ischemic colitis (14 %). Operative mortality is 10,8 %, higher in ischemic colitis (20 %) than in complicated diverticulitis (6,5 %) and cancer (13,4 %). Overall mo rbidity has significantly reduced, from 65,51 % to 17,24 %. General co mplications have changed a little, while local and/or inherent operati ve com plicatians have reduced from 22,4 % to 1,72. Restoration of col orectal continuity was done in 59,54 % of patients, increasing from 36 % to 71 % during the three periods. This is variable depending on ini tial disease : 92 % in diverticular disease, 69 % in ischemic colitis but remains stable for carcinoma at 33 %. Overall mortality since 1981 is 2,5 % and morbidity is 19,13 %. Mean Hospital stay was 20 days for the initial operation and 15 days for secondary restoration of colore ctal continuity Hartmann's procedure is well indicated as emergency su rgery in colonic perforations, abcesses and ischemiae. Progressive imp rovement of its results is essentially due to persistent attention to indications and technical details.