Suthakaran Reshi, Faragher Ian G, Yeung Justin M C
Department of Colorectal Surgery, Western Health, Melbourne, Victoria, Australia.
Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2023 Jan;93(1-2):214-218. doi: 10.1111/ans.18045. Epub 2022 Sep 20.
Real-world data on outcomes following Hartmann's reversal is necessary to help optimize the patient experience. We have explored the timing between the index operation and its reversal; what investigations were carried out prior to this, and the associated short-term outcomes.
A retrospective study of all patients who underwent Hartmann's reversal from 2010 to 2020 within a tertiary referral centre in Melbourne, Australia. One hundred from a total of 406 (25%) who underwent an emergency Hartmann's procedure had a subsequent reversal. Complete patient data was available for 83 of these patients.
The average patient age was 60 years, and the median time for reversal was 14.0 (IQR 10-23) months. Seventy-nine of 83 (95%) reversals had a preoperative endoscopic evaluation of both their rectal stump and a complete colonoscopy. Stoma stenosis (n = 2), patient refusal (n = 1) and emergency reversal (n = 1) were cited reasons for not undergoing preoperative endoscopic evaluation. A third (n = 28, 34%) had a computed tomography prior to reversal; the majority was due to their underlying cancer surveillance (n = 21, 75%). Reversal was associated with a morbidity rate of 47% (n = 39). Surgical site infections (SSIs) (n = 21, 25%) were the most common type of complications encountered, with the majority being superficial (n = 15, 71%). SSIs were associated with steroid use (5/21 versus 4/62, p = 0.03) and greater hospital length of stay (6 versus 10 days, p = 0.03).
Only a quarter of emergency Hartmann's procedures within our institution were reversed. A significant proportion developed postoperative complications. Surgical site infection was the most common morbidity.
关于哈特曼氏手术回纳术后结局的真实世界数据对于优化患者体验至关重要。我们探讨了初次手术与回纳术之间的时间间隔；在此之前进行了哪些检查，以及相关的短期结局。
对2010年至2020年在澳大利亚墨尔本一家三级转诊中心接受哈特曼氏手术回纳术的所有患者进行回顾性研究。在总共406例接受急诊哈特曼氏手术的患者中，有100例（25%）随后进行了回纳术。其中83例患者有完整的患者数据。
患者平均年龄为60岁，回纳术的中位时间为14.0（四分位间距10 - 23）个月。83例回纳术中的79例（95%）在术前对直肠残端和全结肠镜进行了内镜评估。造口狭窄（n = 2）、患者拒绝（n = 1）和急诊回纳（n = 1）被列为未进行术前内镜评估的原因。三分之一（n = 28，34%）的患者在回纳术前进行了计算机断层扫描；大多数是由于其潜在的癌症监测（n = 21，75%）。回纳术的发病率为47%（n = 39）。手术部位感染（SSIs）（n = 21，25%）是最常见的并发症类型，大多数为表浅感染（n = 15，71%）。手术部位感染与使用类固醇有关（5/21对4/62，p = 0.03）以及住院时间延长有关（6天对10天，p = 0.03）。
我们机构内只有四分之一的急诊哈特曼氏手术进行了回纳。很大一部分患者出现了术后并发症。手术部位感染是最常见的发病情况。
