Department of Surgery B, Meir Medical Center, 4428164, Kfar Saba, Israel.
Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Sci Rep. 2021 Jan 14;11(1):1390. doi: 10.1038/s41598-021-81064-3.
Post operative ventral hernias are common following Hartmann's procedure. There is a debate whether hernia repair is safe when performed concomitantly with colostomy closure. In this study we aimed to evaluate the outcomes of synchronous Hartmann reversal (HR) with a hernia repair, compared to a staged procedure. A retrospective multi-center study was conducted, including all patients who underwent Hartmann's procedure from January 2004 to July 2017 in 5 medical centers. Patient data included demographics, surgical data and post-operative outcome. Two hundred and seventy-four patients underwent colostomy reversal following Hartmann's procedure. In 107 patients (39%) a concomitant ventral hernia was reported during the Hartmann's reversal. Out of this cohort, 62 patients (58%) underwent hernia repair during follow-up. Thirty two patients (52%) underwent a synchronous hernia repair and 30 patients (48%) underwent hernia repair as a separate procedure. Post operative complication rate was significantly higher in the colostomy reversal with synchronous hernia repair group when compared to HR alone group (53% vs. 20%; p < 0.01; OR 4.5). In addition, severe complication rate (Clavien-Dindo score ≥ 3) was higher in the synchronous hernia repair group (25% vs. 7%). A tendency for higher hernia recurrence rate was noted in the synchronous group (56% vs. 40%). Median follow up time was 2.53 years (range 1-13.3 years). Synchronous colostomy closure and ventral hernia repair following Hartmann's procedure carries a significant risk for post operative complications, indicating that a staged procedure might be preferable.
术后腹疝是Hartmann 手术后的常见并发症。对于同时行造口还纳和疝修补术是否安全存在争议。本研究旨在评估Hartmann 反转（HR）同期疝修补术与分期手术的治疗效果。本研究为回顾性多中心研究，纳入了 2004 年 1 月至 2017 年 7 月期间在 5 个医疗中心接受 Hartmann 手术的所有患者。患者数据包括人口统计学、手术数据和术后结果。274 例患者在 Hartmann 手术后行结肠造口还纳术。其中 107 例（39%）在 Hartmann 反转期间报告并发腹疝。在这组患者中，62 例（58%）在随访期间接受了疝修补术。32 例（52%）患者同期行疝修补术，30 例（48%）患者分期行疝修补术。同期行疝修补术的结肠造口还纳术后并发症发生率明显高于单纯 HR 组（53% vs. 20%；p < 0.01；OR 4.5）。此外，同期疝修补组严重并发症发生率（Clavien-Dindo 评分≥3）更高（25% vs. 7%）。同期组疝复发率也有增高趋势（56% vs. 40%）。中位随访时间为 2.53 年（范围 1-13.3 年）。Hartmann 术后同期行结肠造口关闭和腹疝修补术有发生术后并发症的高风险，提示分期手术可能更可取。
