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

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Title: Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago.
Authors: Perrone, Gennaro1, Giuffrida, Mario2,3 mario.giuffrida4@gmail.com, Abu-Zidan, Fikri4, Kruger, Vitor F.5, Livrini, Marco1, Petracca, Gabriele Luciano1, Rossi, Giorgio1, Tarasconi, Antonio6, Tian, Brian W. C. A.7, Bonati, Elena2, Mentz, Ricardo8, Mazzini, Federico N.8, Campana, Juan P.8, Gasser, Elisabeth9, Kafka-Ritsch, Reinhold9, Felsenreich, Daniel M.10, Dawoud, Christopher10, Riss, Stefan10, Gomes, Carlos Augusto11, Gomes, Felipe Couto11
Source: World Journal of Emergency Surgery. 4/16/2024, Vol. 19 Issue 1, p1-16. 16p.
Subject Terms: *COLON diseases, *SURGICAL anastomosis, *SCIENTIFIC observation, *DESCRIPTIVE statistics, *LONGITUDINAL method, *SURGICAL complications, *MEDICAL emergencies, *RESEARCH, *OSTOMY, *PATIENT aftercare, DIGESTIVE organ surgery
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. [ABSTRACT FROM AUTHOR]
Copyright of World Journal of Emergency Surgery is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22World+Journal+of+Emergency+Surgery%22&quot;&gt;World Journal of Emergency Surgery&lt;/searchLink&gt;. 4/16/2024, Vol. 19 Issue 1, p1-16. 16p.
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– Name: Abstract
  Label: Abstract
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  Data: Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann&#39;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 &#177; 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 &lt; 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&#39;s procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment&#39;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. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of World Journal of Emergency Surgery is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder&#39;s express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1186/s13017-024-00543-w
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