Consequences of Preoperative Evaluation in Hartmann’s Reversal: Futile or Valuable?
Sanne C. Jaarsma, Y. Tina van Loon, Barbara S. Langenhoff, Maaike S. Ibelings, G. van Tilborg, David D. E. Zimmerman, Dareczka K. WasowiczAbstract
Background:
A Hartmann’s reversal (HR) is commonly preceded by both endoscopic and contrast radiographic imaging to assess the rectal remnant. However, evidence regarding the clinical utility and impact of this preoperative evaluation on surgical management and outcomes is not well established.
Objectives:
To assess the value of routine preoperative evaluation in preparation for HR.
Design:
Retrospective cohort study.
Settings:
The study was conducted at a single teaching hospital in the Netherlands.
Patients and Methods:
A retrospective cohort analysis was performed on 62 HR cases between 2011 and 2024. Routine preoperative evaluation included sigmoidoscopies and contrast radiography. Outcomes assessed included abnormal findings during evaluation (radiology or endoscopy), impact on surgical planning, operative success rates, and postoperative complications.
Main Outcome Measure:
The main outcomes included the impact of abnormal findings on surgical management, operative success rates, and postoperative complications.
Sample Size:
62 HR cases.
Results:
Of the 62 cases evaluated preoperatively, abnormal findings were observed in six (9.7%). These findings led to additional imaging in four cases and altered surgical timing in only one case. The overall success rate of HR was 95.2%, and postoperative complications occurred in 17.8% of cases. Evaluation did not predict adverse perioperative findings, such as severe adhesions, which led to unsuccessful HR in three patients.
Conclusions:
Routine preoperative evaluation did not significantly influence surgical management or outcomes in HR, suggesting it may be unnecessary in routine practice. Selective evaluation may reduce patient burden and health care costs without compromising clinical outcomes.
Limitations:
The sample size (n = 62) is small, limiting the strength and generalizability of the findings. The study lacks a control group and did not compare the relative efficacy of different evaluation modalities.