Restoration of Digestive Continuity after Hartmann's Procedure : ASA Score is a Predictive Factor for Risk of Postoperative Complications

Background/aims : Re-establishment of colonic continuity (RDC) following Hartmann's procedure is associated with high morbidity (anastomotic leak 4-16%) and mortality (0-4%) rates. The aim of this retrospective study was to evaluate the morbidity of RDC following Hartmann's procedure, and analyse the various factors that may influence the rate of complications. Methodology : From 1996 to 2009, 158 patients were treated by Hartmann's colectomy. Hartmann's procedure is generally indicated in cases with infection in the abdominal cavity, combined with a distended or non-prepared intestine, or both. Of the 158 patients, 111 (70.3%) underwent a re-establishment of colonic continuity. The mean patient age was 63.4 years (26-91 years); the female/male ratio was 1:64. Results : The mean delay between the Hartmann's procedure and the RDC was 169 7 days (21-1095 days) and the mean duration of the hospital stay was 16.7 days (8-57 days). The mortality rate was 0.9% and incidence of anastomotic stricture was 3.6%. The morbidity was 38.7%. The majority of patients presenting complications had an ASA score > II, and most of the patients without complications were classified as ASA <= II. Conclusions : The RDC is an intervention performed safely after a 3 to 5-month delay with acceptable morbidity and negligible mortality. The ASA score is a determining factor for the risk. of complications (p < 0.05).