[In Process Citation]

Abstract

BACKGROUND: Although the majority of surgeons regard Hartmann's operation as therapeutic standard in perforations of the colon complicated by peritonitis this procedure has been critically discussed in recent years. Advocates of one-stage techniques criticized bad postoperative results (high morbidity and mortality) and long-term outcome (low rates of intestinal restoration). The aim of our study was to investigate whether the late results after Hartmann's operation justify this criticism. METHOD: From 1982 to 1997 Hartmann's operations were performed in 103 patients for colonic perforations. In 63% of cases inflammatory diseases caused colonic complications. The average Mannheimer Peritonitis Index (MPI) was 19. Seventeen patients died postoperatively (mortality: 16.5%). In 69 patients (80%) intestinal restoration could be performed after an average interval of 122 days (complication rate: 6%, no mortality). On follow-up, patients were asked to give information on their general state, changes of housing, abdominal complaints, and quality of life. RESULTS: Data on 93% of patients could be obtained. The median follow-up time was 75 months. Eleven patients had died; the remaining 72 were investigated. 86% described the quality of their lives as good or very good; only 11% indicated severe loss of activity. Quality of life did not differ between patients in whom intestinal continuity had been restored and those in whom it had not been restored. Anastomotic structures developed in 7% of cases, always after stapled anastomosis. CONCLUSIONS: According to our results, long-term outcome after Hartmann's operation is good. 80% of patients underwent intestinal restoration with low morbidity (6%) and no mortality. A great majority of patients indicated the quality of their lives as good or very good: this assessment was not dependent on restoration of intestinal continuity.