Abstract
Background: Literature 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. Methods: This 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. Results: 564 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 < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 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.
| Original language | English (US) |
|---|---|
| Article number | 14 |
| Journal | World Journal of Emergency Surgery |
| Volume | 19 |
| Issue number | 1 |
| DOIs | |
| State | Published - Dec 2024 |
| Externally published | Yes |
All Science Journal Classification (ASJC) codes
- Surgery
- Emergency Medicine
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In: World Journal of Emergency Surgery, Vol. 19, No. 1, 14, 12.2024.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Goodbye Hartmann trial
T2 - a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago
AU - Perrone, Gennaro
AU - Giuffrida, Mario
AU - Abu-Zidan, Fikri
AU - Kruger, Vitor F.
AU - Livrini, Marco
AU - Petracca, Gabriele Luciano
AU - Rossi, Giorgio
AU - Tarasconi, Antonio
AU - Tian, Brian W.C.A.
AU - Bonati, Elena
AU - Mentz, Ricardo
AU - Mazzini, Federico N.
AU - Campana, Juan P.
AU - Gasser, Elisabeth
AU - Kafka-Ritsch, Reinhold
AU - Felsenreich, Daniel M.
AU - Dawoud, Christopher
AU - Riss, Stefan
AU - Gomes, Carlos Augusto
AU - Gomes, Felipe Couto
AU - Gonzaga, Ricardo Alessandro Teixeira
AU - Canton, Cassio Alfred Brattig
AU - Pereira, Bruno Monteiro
AU - Fraga, Gustavo P.
AU - Zem, Leticia Gonçalves
AU - Cordeiro-Fonseca, Vinicius
AU - de Mesquita Tauil, Renato
AU - Atanasov, Boyko
AU - Belev, Nikolay
AU - Kovachev, Nikola
AU - Meléndez, L. Juan José
AU - Dimova, Ana
AU - Dimov, Stefan
AU - Zelić, Zdravko
AU - Augustin, Goran
AU - Bogdanić, Branko
AU - Morić, Trpimir
AU - Chouillard, Elie
AU - Bajul, Melinda
AU - De Simone, Belinda
AU - Panis, Yves
AU - Esposito, Francesco
AU - Notarnicola, Margherita
AU - Lauka, Lelde
AU - Fabbri, Anna
AU - Hentati, Hassen
AU - Fnaiech, Iskander
AU - Aurélien, Venara
AU - Bougard, Marie
AU - Roulet, Maxime
AU - Demetrashvili, Zaza
AU - Pipia, Irakli
AU - Merabishvili, Giorgi
AU - Bouliaris, Konstantinos
AU - Koukoulis, Georgios
AU - Doudakmanis, Christos
AU - Xenaki, Sofia
AU - Chrysos, Emmanuel
AU - Kokkinakis, Stamatios
AU - Vassiliu, Panteleimon
AU - Michalopoulos, Nikolaos
AU - Margaris, Ioannis
AU - Kechagias, Aristotelis
AU - Avgerinos, Konstantinos
AU - Katunin, Jevgeni
AU - Lostoridis, Eftychios
AU - Nagorni, Eleni Aikaterini
AU - Pujante, Antonio
AU - Mulita, Francesk
AU - Maroulis, Ioannis
AU - Vailas, Michail
AU - Marinis, Athanasios
AU - Siannis, Ioannis
AU - Bourbouteli, Eirini
AU - Manatakis, Dimitrios K.
AU - Tasis, Nikolaos
AU - Acheimastos, Vasileios
AU - Maria, Sotiropoulou
AU - Stylianos, Kapiris
AU - Kuzeridis, Harilaos
AU - Korkolis, Dimitrios
AU - Fradelos, Evangelos
AU - Kavalieratos, George
AU - Petropoulou, Thalia
AU - Polydorou, Andreas
AU - Papacostantinou, Ioannis
AU - Triantafyllou, Tania
AU - Kimpizi, Despina
AU - Theodorou, Dimitrios
AU - Toutouzas, Konstantinos
AU - Chamzin, Alexandros
AU - Frountzas, Maximos
AU - Schizas, Dimitrios
AU - Karavokyros, Ioannis
AU - Syllaios, Athanasios
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AU - Baili, Efstratia
AU - Ioannidis, Orestis
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AU - Fogato, Luisella
AU - Cavallo, Fabio
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AU - Picheo, Roberto
AU - Pontarolo, Nicholas
AU - Depalma, Norma
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AU - D’Ugo, Stefano
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AU - Capponi, Michela Giulii
AU - Campa, Rossella Domenica
AU - Sarro, Giuliano
AU - Dinuzzi, Vincenza Paola
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AU - Picariello, Erika
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AU - Lecchi, Francesca
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AU - Balla, Andrea
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AU - Ambrosi, Antonio
AU - Pavone, Giovanna
AU - Palini, Gian Marco
AU - Veneroni, Simone
AU - Garulli, Gianluca
AU - Ricci, Claudio
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AU - Lapolla, Pierfrancesco
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AU - Alconchel, Felipe
AU - Nicolás-López, Tatiana
AU - Rahy-Martin, Aida Cristina
AU - Pelloni, María
AU - Bañolas-Suarez, Raquel
AU - Mendoza-Moreno, Fernando
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AU - Rodas, María Elisa Valle
AU - Agundez, María Carmona
AU - Andrés, María Inmaculada Pérez
AU - Moreira, Claudia Cristina Lopes
AU - Perez, Aintzane Lizarazu
AU - Ponce, Iñigo Augusto
AU - González-Castillo, Ana María
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AU - Salvans, Silvia
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AU - Romacho-López, Laura
AU - Sánchez-Guillén, Luis
AU - Aranaz-Ostariz, Veronica
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AU - Alegre, Javier Martínez
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AU - Lohsiriwat, Varut
AU - Mongkhonsupphawan, Aitsariya
AU - Baraket, Oussama
AU - Ayed, Karim
AU - Abbassi, Imed
AU - Ali, Ali Ben
AU - Ammar, Houssem
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AU - Polat, Suleyman
AU - Koylu, Zehra Alan
AU - Guner, Ali
AU - Usta, Mehmet Arif
AU - Reis, Murat Emre
AU - Mantoglu, Baris
AU - Gonullu, Emre
AU - Akin, Emrah
AU - Altintoprak, Fatih
AU - Bayhan, Zulfu
AU - Firat, Necattin
AU - Isik, Arda
AU - Memis, Ufuk
AU - Bayrak, Mehmet
AU - Altıntaş, Yasemin
AU - Kara, Yasin
AU - Bozkurt, Mehmet Abdussamet
AU - Kocataş, Ali
AU - Das, Koray
AU - Seker, Ahmet
AU - Ozer, Nazmi
AU - Atici, Semra Demirli
AU - Tuncer, Korhan
AU - Kaya, Tayfun
AU - Ozkan, Zeynep
AU - Ilhan, Onur
AU - Agackiran, Ibrahim
AU - Uzunoglu, Mustafa Yener
AU - Demirbas, Eren
AU - Altinel, Yuksel
AU - Meric, Serhat
AU - Hacım, Nadir Adnan
AU - Uymaz, Derya Salim
AU - Omarov, Nail
AU - Balık, Emre
AU - Tebala, Giovanni D.
AU - Khalil, Hany
AU - Rana, Mridul
AU - Khan, Mansoor
AU - Florence, Charlotte
AU - Swaminathan, Christie
AU - Leo, Cosimo Alex
AU - Liasis, Lampros
AU - Watfah, Josef
AU - Trostchansky, Ivan
AU - Delgado, Edward
AU - Pontillo, Marcelo
AU - Latifi, Rifat
AU - Coimbra, Raul
AU - Edwards, Sara
AU - Lopez, Ana
AU - Velmahos, George
AU - Dorken, Ander
AU - Gebran, Anthony
AU - Palmer, Amanda
AU - Oury, Jeffrey
AU - Bardes, James M.
AU - Seng, Sirivan Suon
AU - Coffua, Lauren S.
AU - Ratnasekera, Asanthi
AU - Egodage, Tanya
AU - Echeverria-Rosario, Karla
AU - Armento, Isabella
AU - Napolitano, Lena M.
AU - Sangji, Naveen F.
AU - Hemmila, Mark
AU - Quick, Jacob A.
AU - Austin, Tyler R.
AU - Hyman, Theodore S.
AU - Curtiss, William
AU - McClure, Amanda
AU - Cairl, Nicholas
AU - Biffl, Walter L.
AU - Truong, Hung P.
AU - Schaffer, Kathryn
AU - Reames, Summer
AU - Banchini, Filippo
AU - Capelli, Patrizio
AU - Coccolini, Federico
AU - Sartelli, Massimo
AU - Bravi, Francesca
AU - Vallicelli, Carlo
AU - Agnoletti, Vanni
AU - Baiocchi, Gian Luca
AU - Catena, Fausto
N1 - Publisher Copyright: © The Author(s) 2024.
PY - 2024/12
Y1 - 2024/12
N2 - Background: Literature 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. Methods: This 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. Results: 564 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 < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 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.
AB - Background: Literature 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. Methods: This 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. Results: 564 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 < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 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.
UR - https://www.scopus.com/pages/publications/85190584518
UR - https://www.scopus.com/pages/publications/85190584518#tab=citedBy
U2 - 10.1186/s13017-024-00543-w
DO - 10.1186/s13017-024-00543-w
M3 - Article
C2 - 38627831
AN - SCOPUS:85190584518
SN - 1749-7922
VL - 19
JO - World Journal of Emergency Surgery
JF - World Journal of Emergency Surgery
IS - 1
M1 - 14
ER -