HARTMANN PROCEDURE - INDICATIONS AND LIMI TATIONS - A REVIEW OF 27 CASES

From 1984 to 1993, Hartmann's procedure was performed in 14 men and 13 women, with a mean age of 63 years, on an emergency basis in 20 patie nts and electively in seven. The bowel disease was colorectal cancer i n 22 cases, volvulus of the sigmoid colon in four, and sigmoid colon i nvasion by an ovarian cancer in one. Six patients (25.8%) died postope ratively. Among the 21 survivors, 14 (66.6%) underwent anastomosis to reconstitute bowel continuity within a mean interval of 100 days. The reason for failure to reconstitute continuity in the other followed-up patients was progression of the malignant process in every case. In t he long term, among the 27 patients who had the procedure, only 13 (48 %) were still alive with reconstituted bowel continuity. In conclusion , Hartmann's procedure is sometimes the only recourse in patients with complicated colorectal diseases but is associated with patient discom fort, nonnegligible mortality, and uncertain chances for reconstitutio n of continuity; therefore, its indications should be limited and its technique faultless.