“Reversal of the end colostomy following a Hartmann’s procedure (HP) remains a frequently performed operation, undertaken by colorectal and general surgeons. While Henri Hartmann initially described the procedure in 1921 as a treatment for rectosigmoid cancer, it is now most commonly employed in cases of Hinchey 3 and 4 diverticulitis, where performance of a primary anastomosis is considered unsafe. Trauma, colorectal malignancy, inflammatory bowel disease and ischaemic colitis are other common reasons for performing HP in the USA. Ideally, Hartmann’s reversal (HR) is performed once the patient has recovered from the initial illness in order to re-establish intestinal continuity and avoid a permanent stoma. Historically this procedure has had low rates of success and a high morbidity, leading
to the presence of a permanent stoma in a substantial percentage of patients.

“This paper analyses a large institutional series of reversal of Hartmann’s procedure and provides a new perspective on the outcomes in specialized referral centres. Restoration
of bowel continuity following Hartmann’s procedure is a major surgical undertaking and in previously published literature has been associated with a low probability of success. Although it is associated with significant morbidity we describe a high success rate for restoration of intestinal continuity, at times in patients who have been denied surgery at other locations.”

“The experience with surgery for stoma reversal following HP described in this study suggests that successful restoration of intestinal continuity can be achieved at a significantly higher rate than previously published. There is significant morbidity associated with
undertaking these challenging cases, and that risk is greater among obese patients. Use of a laparoscopic approach may be associated with modest decreases in morbidity in selected patients but has a high conversion rate.”

Mirza, Kasim L et al. “Outcomes of colostomy takedown following Hartmann’s procedure: successful restoration of continuity comes with a high risk of morbidity.” Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland vol. 23,4 (2021) Full Text for Emory Users