HARTMANN'S PROCEDURE: FIRST CHOICE OR LAST RESORT?

Hartmann's procedure is suitable operation and its indications are extended for different kinds of pathologies of rectum and sigmoid colon when primary restorative resection cannot be safely performed. During the June 1992 to 1997 time period, we analyze our experience in the 31 patients who underwent Hartmann's procedure at the Department of Surgery, Dokuz Eylül Universty Hospital. There were 16 men and 15 women, with a median age of 65 (range 32-88) years. Twenty seven (87,1%) patients were operated for emergent diseases, four (12,9%) patients for elective conditions. The pathologic process encountered was benign in 19 (61,3%) and malign in 12 (38,7%). The median time interval for Hartmann's procedure to reversal was 86 (range 54-300) days in only 17 (62,99%) of these patients. The mortality rate of primary procedure was 12,9% and important morbidity was 29,3%. No anastomotic leak and mortality was found following ostomy closure. Morbidity due to another reasons occurred in 3 patients (17,6%). There has been a notable but progressive decline in the seemingly high incidence of morbidity and in the technical difficulty frequently associated with Hartmann's procedure and its reversal. So, Hartmann's procedure can be selected as "a first choice" or "a hist resort" operation in high risk patients.

HARTMANN ÝÞLEMÝ: ÝLK TERCÝH MÝ, SON ÇAREMÝ?

Hartmann iþlemi, primer anastomozun güvenilir olmadýðý sigmoid ve rektumun üst kesimini içeren, deðiþik patolojiler endikasyonu olan bir giriþimdir. Çalýþmamýzda Dokuz Eylül Üniversitesi Hastanesi'nde 1992-1997 arasýnda Hartmann iþlemi yapýlan 31 hastadaki deneyimimiz incelenmiþtir. Hastalarýn 16'sý erkek, 15'i kadýn olup ortalama yaþ 65 (32-88)'ti. Hastalarýn 27'si (%87,1) acil, 4'ü (%12,9) efektif þartlarda opere edilmiþ olup 19'unda (%61,3) benign, 12'sinde (%38,7) malign patolojiler mevcuttu. Bu hastalarýn 17'sinde (%62,9), ortalama 86 (54-300) gün sonra anastomoz yapýlarak devamlýlýk saðlandý. Primer iþlemde mortalite %12,9; morbidite %29,3'tü. Anastomoz yapýldýktan sonra kaçak ve mortalite izlenmedi. Üç hastada (%17,6) baþka nedenlere baðlý morbidite geliþti. Geçmiþte vurgulanan rekonstrüksiyon güçlüðünün belli oranda aþýlmasý ve yüksek seyreden morbidite ve mortalite oranýnýn giderek azalmasý nedeniyle Hartmann iþlemi, yüksek riskli hastalarda sýrasýnda ilk tercih, sýrasýnda son çare olarak seçilebilen bir yöntemdir.