Department of Surgery, University of Wisconsin, G4/701 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-7375, USA.
J Gastrointest Surg. 2009 Dec;13(12):2260-7. doi: 10.1007/s11605-009-0987-3. Epub 2009 Sep 2.
Reversal of Hartmann's is a common surgical procedure. Routine preoperative evaluation of the distal colonic/rectal remnant (DCRR) with contrast and/or endoscopic studies is frequently performed despite lack of evidence to support this practice. We hypothesize that asymptomatic patients can safely undergo Hartmann's reversal without preoperative DCRR evaluation.
Adult patients undergoing reversal of Hartmann's at a single institution were retrospectively identified. Operative characteristics and outcomes in patients with and without preoperative DCRR evaluation were compared.
Between 1993 and 2008, 203 patients underwent reversal of Hartmann's at a tertiary referral center. Sixty-eight patients (33%) did not undergo preoperative DCRR evaluation and had comparable demographic characteristics, comorbidities, DCRR length, and perioperative outcomes to 135 patients who underwent preoperative contrast and/or endoscopic studies. After evaluation, 125 (93%) patients had normal findings, seven (5%) patients had abnormal studies that did not impact their management, and three (2%) patients underwent additional procedures.
Hartmann's reversal without previous DCRR evaluation is acceptable in selected asymptomatic patients, without increased risk of complications.
Hartmann 手术的逆转是一种常见的外科手术。尽管缺乏证据支持这一做法，但经常对远端结肠/直肠残端（DCRR）进行常规术前对比和/或内镜检查。我们假设无症状患者可以安全地进行 Hartmann 手术逆转，而无需进行术前 DCRR 评估。
回顾性地确定了在一家机构接受 Hartmann 手术逆转的成年患者。比较了术前进行 DCRR 评估与未进行评估的患者的手术特点和结果。
1993 年至 2008 年间，在一家三级转诊中心有 203 例患者接受了 Hartmann 手术的逆转。68 例（33%）患者未进行术前 DCRR 评估，与 135 例接受术前对比和/或内镜检查的患者相比，具有相似的人口统计学特征、合并症、DCRR 长度和围手术期结局。评估后，125 例（93%）患者的检查结果正常，7 例（5%）患者的检查结果异常，但不影响其治疗，3 例（2%）患者接受了额外的手术。
在选定的无症状患者中，不进行术前 DCRR 评估而进行 Hartmann 手术逆转是可以接受的，不会增加并发症的风险。
