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Its Use With Complicated Carcinomas of Sigmoid Colon and Rectum

Stephen G. ReMine, MD; Roger R. Dozois, MD

Arch Surg. 1981;116(5):630-633.

Abstract
• We assessed the safety of Hartmann's procedure in terms of postoperative morbidity and mortality associated not only with the original operation, but also with reestablishment of colorectal continuity and long-term survival. We studied 107 consecutive patients in whom Hartmann's procedure was performed either electively (96) or as an emergency (11) between 1970 and 1975. In 87, the resection extended below the peritoneal reflection. The mean age of the patients was 67 years. The principal indication for Hartmann's procedure was palliation (53%), obstruction (42%) either alone or with perforation, and technical difficulties (5%). Four patients died (3.7%) in the immediate postoperative period, two after elective surgery (2.1%). Complications were observed in 35 patients, including wound infection or dehiscence (22), urinary tract problems (seven), and pelvic abscess (three). Colorectal continuity was reestablished in ten patients without mortality or morbidity. The mean five-year survival for Dukes' B, C, and D lesions was 54%, 23%, and 3%, Hartmann's procedure, when performed for complicated carcinomas of sigmoid colon and rectum, including subsequent restoration of bowel continuity, is safe and can be associated with long-term survival.

(Arch Surg 1981;116:630-633)

Author Affiliations
From the Department of Surgery, Mayo Graduate School of Medicine, Mayo Foundation and Clinic, Rochester, Minn.

Footnotes
Accepted for publication Jan 5, 1981.

Read before the 88th annual meeting of the Western Surgical Association, Salt Lake City, Nov 18, 1980.

Reprint requests to Department of Surgery, Mayo Clinic, Rochester, MN 55901 (Dr Dozois).

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