THE UTILITY OF THE HARTMANN PROCEDURE

BACKGROUND: In 1923 the French surgeon Henri Hartmann described an ope ration for rectosigmoid cancer as an alternative to abdomino-perineal resection for high-risk patients. In the subsequent years, the indicat ions for performing the Hartmann procedure have broadened to include c omplicated diverticulitis, ischemic bowel, iatrogenic perforations, vo lvulus, and colitis. METHODS: We have retrospectively reviewed our exp erience in 185 patients who underwent the Hartmann procedure from Janu ary 1981 to December 1995. Charts were reviewed for indications, morbi dity, and mortality and to determine the outcome of patients who under went the Hartmann procedure. RESULTS: The main indications for perform ing the Hartmann procedure were complicated diverticulitis (including perforation, obstruction, and abscesses) in 108 patients, rectosigmoid cancer in 31 patients, and other indications in 46 patients. There we re a total of 27 deaths for an in-hospital mortality of 14%. All compl ications occurred at a rate of less than 9%. Of the 158 surviving pati ents, 90 (57%) eventually underwent the second stage of the operation to restore bowel continuity. The average length of time between initia l resection and reanastomosis was 149 days. There were no deaths assoc iated with the second stage of the procedure and complications occurre d at a rate less than 4%. CONCLUSIONS: This is the largest reviewed se ries of the Hartmann procedure. Mortality is lower than in other repor ted series, and morbidity is low. Our data demonstrate that the second stage of the procedure, in properly selected individuals, is a proced ure that can be performed with minimal morbidity and no mortality. Thi s is different from other published reports. We conclude that the Hart mann procedure is a safe and efficacious option for the surgeon confro nted with the complex pathology of the rectosigmoid area, with accepta ble morbidity and mortality. (C) 1998 by Excerpta Medica, Inc.