Long-term results after Hartmann's operation

Background: Although the majority of surgeons regard Hartmann's operation a s therapeutic standard in perforations of the colon complicated by peritoni tis this procedure has been critically discussed in recent years. Advocates of one-stage techniques criticized bad postoperative results (high morbidi ty and mortality) and long-term outcome (low rates of intestinal restoratio n). The aim of our study was to investigate whether the late results after Hartmann's operation justify this criticism. Method: From 1982 to 1997 Hart mann's operations were performed in 103 patients for colonic perforations. In 63% of cases inflammatory diseases caused colonic complications. The ave rage Mannheimer Peritonitis Index (MPI) was 19. Seventeen patients died pos toperatively (mortality: 16.5%). In 69 patients (80%) intestinal restoratio n could be performed after an average interval of 122 days (complication ra te: 6%, no mortality). On follow-up, patients were asked to give informatio n on their general state, changes of housing, abdominal complaints, and qua lity of life. Results: Data on 93 % of patients could be obtained. The medi an follow-up time was 75 months. Eleven patients had died; the remaining 72 were investigated. 86 % described the quality of their lives as good or ve ry good; only 11% indicated severe loss of activity. Quality of life did no t differ between patients in whom intestinal continuity had been restored a nd those in whom it had not been restored. Anastomotic strictures developed in 7% of cases, always after stapled anastomosis. Conclusions: According t o our results, long-term outcome after Hartmann's operation is good. 80 % o f patients underwent intestinal restoration with low morbidity (6%) and no mortality. A great majority of patients indicated the quality of their live s as good or very good: this assessment was not dependent on restoration of intestinal continuity.