Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Journal article

BackgroundLiterature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA.MethodsThis is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up.Results564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P ConclusionsAfter 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception.

Authors: Perrone, G; Giuffrida, M; Abu-Zidan, F; Kruger, VF; Livrini, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BioMed Central
• Journal: World Journal of Emergency Surgery
• Volume: 19
• Issue: 1
• Pages: 14
• Publication date: 2024-04-16
• DOI: 10.1186/s13017-024-00543-w
• ISSN: 1749-7922
• Pmid: 38627831
• Language: English
• Keywords: Ostomy; Humans; Resection; Diverticulitis; Hartmann’s Procedure; Prospective Studies; Colorectal Neoplasms; Aged, 80 and over; Middle Aged; Emergency Surgery; Aged; Primary Anastomosis; Male; Postoperative Complications; Colorectal Cancer; Left Side; Anastomosis, Surgical; Colon; Emergencies; Female