Technical Difficulties and Complication During Hartmann’s Reversal: 5-Year Experience At Tertiary Care Hospital

Shahneela Manzoor, Muhammad Naeem Khan, Shabina Jaffar, Mazhar Iqbal, Mariyah Anwer, Hira Moosa

Abstract

Objective 

To find out the technical difficulties and complications during Hartmann’s reversal procedure.

Study design 

Cross sectional observational study..

Place & Duration of study

Department of General Surgery Ward-2, Jinnah Postgraduate Medical Center Karachi, from December 2017 to December 2022.

Methodology•

All patients in whom Hartmann’s reversal procedure done, were included in the study. Technical difficulties during operation, postoperative complications, morbidity and mortality were recorded. Descriptive statistics were used to present the data. Confidence interval and z-values were calculated. A p value of <0.05 was taken as statistically significant.

Results

A total of 71 patients were operated. There were 34 (47.89%) males and 37 (52.11%) female patients. The age was from 14 years to 71 years with the mean age of 41.02+14.89 years. The median age was 41 years. In 41 (57.75%) patients early reversal and in 30 (42.25%) late reversal procedure was done. In 53 (74.64%) patients surgical stapler was used for the anastomosis and in 15 (21.13%) it was hand sewn.

Complications occurred in 23 (32.39%) patients. This include hemorrhage (n=1 -1.41%), ureteral injury (n=1 - 1.41%), urinary bladder injury (n=5 - 7.04%), anastomotic leakage (n=4 - 5.63%), burst abdomen (n=5 - 7.04%), stricture formation (n=5 - 7.04%), and rectovaginal fistula (n=2 - 2.82%). More complications were observed with stapled anastomosis (n=19) than hand sewn technique (n=4). Complications occurred in 19 patients of early and 04 of late reversal group. Procedure was abandoned in 03 (4.23%) patients. This was due to dense adhesions in 02 (2.82%) and vascular injury in 01 (1.41%) patient. One patient among this group expired.

Conclusion

Morbidity in early reversal patients was more common as compared to late reversal groups. Complications were noted more often in stapled than hand sewn anastomosis technique.

Key words 

Hartmann’s procedure, Reversal, Complications, Technical difficulties, Anastomotic leak.