Keywords
ileostomy
intestinal transit
Hartmann surgery
How to Cite
Abstract
Introduction: Hartmann colostomy is a surgical procedure usually of the left intestine and sigmoid, most used in emergency cases by acute inflammatory abdominal symptoms, occlusive, traumas, neoplasms, etc. The patients who underwent this surgical intervention are in need of the restoration of their intestinal transit.
Objective: to describe the experience in intestinal transit restitution in patients with Hartmann colostomy in the General Surgery Service of the National Hospital between 2017-2019.
Methodology: descriptive, retrospective cross-sectional observational study with nonprobabilistic sampling of consecutive cases.Recordsofpatientswhowereoperated on were used for intestinal restitution.
Results: 23 patient files were analyzed. The most frequent pathologies that originated the ostomy were a history of generalized acute peritonitis of various etiologies, followed by those of neoplastic origin, intestinal occlusion and closed abdominal trauma. The most frequent time between ostomy and restitution surgery was 12 months. The highest percentage of ostomies corresponded to terminal colostomies. Most were colo-colonic terminus anastomosis. Postoperative complications included fecal peritonitis due to anastomosis dehiscence, grade 3 evisceration, and in-hospital pneumonia.
Discussion: The benefits of early restitution have been demonstrated where subsequent complications derived for example from postoperative fibrosis are avoided. Hartmann surgery can offer many benefits in terms of restoring bowel transit, patient recovery and quality of life. Morbidity and mortality through this technique has been low.
References
(1) Sciuto A, Merola G, De Palma GD, Sodo M, Pirozzi F, Bracale UM, Bracale U. Predictivefactorsforanas- tomoticleakageafterlaparoscopiccolorectalsurgery. World J Gastroenterol. 2018 Jun 7;24(21):2247- 2260. doi: 10.3748/wjg.v24.i21.2247.
(2) Pinheiro Regadas FS, Veras Rodrigues L, Murad Regadas SM, Pinheiro Regadas Filho FS, Albuquer- que XerezMartins SM, Pereira Regadas M. Recons- trucción del tránsito intestinal posterior al procedi- miento de Hartmann por acceso videolaparoscópico. Presentación de 50 casos.Revista Mexicana de Co- loproctología Vol. 13, No. 3. Septiembre-Diciembre 2007.
(3) Menahem B, Lubrano J, Vallois A, Alves A. Early Closure of Defunctioning Loop Ileostomy: Is It Bene- ficial for the Patient? A Meta-analysis. World J Surg 2018 Oct;42(10):3171-3178. doi: 10.1007/s00268- 018-4603-0.
(4) Madani R, Day N, Kumar L, Tilney HS, Gudgeon AM. Hand-Sewn versus Stapled Closure of Loop Ileostomy: A Meta-Analysis. DigSurg 2019;36(3):183- 194. doi: 10.1159/000487310. Epub 2018 Mar 7.
(5) Hartmann H. Note sur un procede nouveaud’extir- pation des cancers de la partie du colon. Bull Mem- SocChir Paris. 1923;49:1474-7.
(6) Hartmann H. Nouveauprodeded’ablation des cancers de la partieterminale du colon pelvien. Tren- tiemeCongres de Chirurgie. Strasborg 1923:411-3.
(7) Roe A, Prabhu S, Ali A, Brown C, Broddribb AJ. ReversalofHartmann’sprocedure:timingandoperati- vetechnique. Br J Surg 1991;78:1167-70.
(8) Toro A, Mannino M, Reale G, et al. Primary anas- tomosis vs Hartmann procedure in acute complica- ted diverticulitis. Evolution over the last twenty years. Chirurgia (Bucur); Sep-Oct 2012;107(5):598-604.
(9) Salem L. Flum Primary anastomosis or Hart- mann’s procedure for patients with diverticular pe- ritonitis? A systematic review. Dis Colon Rectum. 2004;47 (11):1953-1964.
(10) Hess GF, Schäfer J, Rosenthal J, et al. Rever- sal after Hartmann’s procedure in patients with complicated sigmoid diverticulitis. Colorectal Dis. 2017;19(6):582-588.
(11) Krouse R, Grant M, Ferrell B, Dean G, Nelson R, Chu D. Qualityoflifeoutcomes in 599 cancerand non-cancerpatientswithcolostomies. J Surg Res. 2007;138:79–87.
(12) Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications following colostomy. Dis Colon Rectum. 1994; 37:916–920.
(13) McMullen CK, Hornbrook MC, Grant M, et al. The greatest challenges reported by long-term colorec- tal cancer survivors with stomas. J Support Oncol. 2008;6:175–182.
(14) Habbir J, Britton DC. Stomacomplications: a lite- rature overview. Color Dis: Off J AssocColoproctol G B Irel. 2010;12:958–964.
(15) Vermeulen J, Gosselink MP, Busschbach JJ, Lange JF. AvoidingorreversingHartmann’s procedu- re providesimprovedqualityoflifeafterperforateddiver- ticulitis. J GastrointestSurg. 2010;14:651-7.
(16) Hodgson R, An V, Stupart DA, Guest GD, Watters DA. Who getsHartmann’sreversed in a regional cen- tre?.Surg: J R Coll SurgEdinbIrel. 2016; 14:184–189.
(17) Ferrara F, Parini D, BondurriA, Veltri M, Barbiera- to M, Pata F, Cattaneo F, Tafuri A, Forni C, Roveron G, Rizzo G, MultidisciplinaryItalianStudygroup for STOmas (MISSTO). Italianguidelines for thesurgical management of enteral stomas in adults. Tech Co- loproctol. 2019 Nov;23(11):1037-1056. doi: 10.1007/ s10151-019-02099-3. Epub 2019 Oct 12.
(18) Harries RL, Torkington J. Stomal Closure: Stra- tegies to Prevent Incisional Hernia. Front Surg. 2018 Apr 4;5:28. doi: 10.3389/fsurg.2018.00028. eCollec- tion 2018.
(19) Goetz A, Platz Batista da Silva N, Moser C, Agha A, Dendl LM, Stroszczynski C, Schreyer AG. Clinical Value of Contrast Enema Prior to Ileostomy Closu- re. Rofo. 2017 Sep;189(9):855-863. doi: 10.1055/s- 0043-111598. Epub 2017 Aug 23.
(20) Wanglin L, Gokhan O. Does the timing of loop ileostomy closure affect outcome: A case-matched study, Int J Surg. 2017 Jul;43:52-55. doi: 10.1016/j. ijsu.2017.05.039. Epub 2017 May 22.
(21) EmrahGoret N, CanbeyGoret C, Cetin K, FeranA- gachan A. Evaluation of risk factors for complications after colostomy closure. Ann Ital Chir. 2019;90:324- 329.
(22) Ambe PC, Kurz NR, Nitschke C, Odeh SF, Mös- lein G, Zirngibl H. Intestinal Ostomy. DtschArztebl Int. 2018 Mar 16;115(11):182-187. doi: 10.3238/ar- ztebl.2018.0182.
(23) UzcáteguiPaz E, Niño Y, Plata J, Fargier-Paoli A, González-Torres C, Cierre temprano de colostomía temporal. AvanBiomed 2012; 1:55-9.
(24) Mengual-Ballester Mónica, García-Marín José Andrés, Pellicer-Franco Enrique, Guillén-Paredes María Pilar, García-García María Luisa, Cases-Bal- dó María José et al . Ileostomías de protección: complicaciones y mortalidad asociadas a su cierre. Rev. esp. enferm. dig. [Internet]. 2012 Jul [citado 2021 Abr 08] ; 104( 7 ): 350-354. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttex- t&pid=S1130-01082012000700003&lng=es. http:// dx.doi.org/10.4321/S1130-01082012000700003.
(25) Rodrigo Oliva Perez 1, Angelita Habr-Gama, Victor E Seid, Igor Proscurshim, Afonso H Sousa Jr, Desidério R Kiss, Marcelo Linhares, Manuela Sapucahy, Joaquim Gama-Rodrigues. Loop ileos- tomy morbidity: timing of closure matters. Dis Colon Rectum. 2006 Oct;49(10):1539-45. doi: 10.1007/ s10350-006-0645-8.
(26) Fonseca AZ, Uramoto E, Santos-Rosa OM, Santin S, Ribeiro Jr M. Colostomy closure: risk factors for complications. Arq Bras Cir Dig. Oct- Dec 2017;30(4):231-234. doi: 10.1590/0102- 6720201700040001.
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