ABSTRACT

INTRODUCTION:

Hartmann’s procedure was performed for the first time in 1923 and still is applied for some left colonic problems. In this study, retrospective investigation of the indications of this procedure in all patients between 2000 and 2005, early and late complications due to the procedure, and their effects on the patient’s quality of life were aimed.

METHODS:

A total of 61 patients (77% male) with median age of 51 years were included in the study. The most common indication for procedure was the complicated rectosigmoid cancer.

RESULTS:

The mortality rate after the first stage of the procedure was 19.7 percent. Abdominal sepsis was the most common reason (50%) for the first stage postoperative deaths. The total complication rate for first stage operations was 59 percent. A second stage operation (stoma closure) was carried out in 19 (39%) of 49 survived patients. Thirty patients refused the stoma closure. Associated diseases (such as hypertension, diabetes mellitus, etc.) and unwillingness of the patients were the main factors of this refusal for further surgery. Three patients died due to abdominal sepsis, pulmonary emboli and pulmonary infection after stoma closure (second stage operation). The complications rate was 37% in this stage. The possible reasons for these high complication rates were evaluated as being elderly, associated diseases, advanced stage of cancer, and diminished host immunity and other side effects due to chemotherapy in cancer patients.

DISCUSSION AND CONCLUSION:

Hartmann’s procedure still has high morbidity and mortality rates. It is necessary to be highly selective in application of the procedure, it can be suitable especially for the elderly, and it should be accepted as a permanent procedure without stoma closure in the majority of the patients.