Reversal of Hartmann's procedure– why is it delayed?

Abstract: Background: Reversal of Hartmann’s procedure with restoration of intestinal continuity increasepatients’ quality of life but entails considerable risks of postoperative morbidity.Aim: Our aim was to investigate the timing of Hartmann’s reversal and factors delaying stomaclosure. Secondarily, postoperative complications in relation to reversal surgery were reviewed.Methods: This retrospective record review evaluated all patients undergoing reversal of Hartmann’sprocedure during a 9yearperiod. Reversal beyond 6 months was deemed delayed. Results: A total of 42 patients were included in the study. Common surgical indications weremalignancy (n=14) and diverticular disease (n=12). Median time to reversal was 12 months. Only12% of stomas were reversed within 6 months, with no significant difference between the malignantand nonmalignantgroups. The remaining 88% were considered delayed reversals. Adjuvantchemotherapy caused a delay in 64% of patients with a malignant surgery indication. In the nonmalignantgroup, low priority within the healthcare system caused 57% of delays, while 17% weredue to the patient’s choice. Postoperative morbidity affected 64% (n=27) of patients. Wound infection(n=8), abscess formation (n=6), ileus (n=7) and incisional hernia (n=8) were the most frequentcomplications. No deaths occurred postoperatively.Conclusion: Almost 9 in 10 patients had a delayed stoma reversal, beyond 6 months. The maincauses were adjuvant chemotherapy and low priority within the healthcare system.