Hartmann's procedure or primary anastomosis?

Digestive Diseases
Martin E KreisWolfgang H Thasler

Abstract

Perforation following acute diverticulitis is a typical scenario during the first attack. Different classification systems exist to classify acute perforated diverticulitis. While the Hinchey classification, which is based on intraoperative findings, is internationally best known, the German Hansen-Stock classification which is based on CT scan is widely accepted within Germany. When surgery is necessary, sigmoid colectomy is the standard of care. An important question is whether patients should receive primary anastomosis or a Hartmann procedure subsequently. A priori there are several arguments for both procedures. Hartmann's operation is extremely safe and, therefore, represents the best option in severely ill patients and/or extensive peritonitis. However, this operation carries a high risk of stoma nonreversal, or, when reversal is attempted, a high risk in terms of morbidity and mortality. In contrast, primary anastomosis with or without loop ileostoma is a slightly more lengthy procedure as normally the splenic flexure needs to be mobilized and construction of the anastomosis may consume more time than the Hartmann operation. The big advantage of primary anastomosis, however, is that there is no need for the potentially ...Continue Reading

References

Jun 15, 2006·Annals of Surgery·Jennifer R ChapmanDirk R Larson
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Citations

Jan 9, 2013·World Journal of Emergency Surgery : WJES·Massimo SartelliTomohisa Shoko
Apr 24, 2015·ANZ Journal of Surgery·Michael K-Y HongAnita R Skandarajah
May 15, 2015·World Journal of Emergency Surgery : WJES·Massimo SartelliFausto Catena
Aug 9, 2016·International Journal of Surgery·Nir HoreshOded Zmora
Nov 3, 2016·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·G F HessD Oertli
Feb 13, 2018·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·A Royo-AznarA Espí-Macías

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