HARTMANN ��LEM�:  �LK TERC�H M�, SON �AREM�?

S�kmen, Selman; Bekta�er, C�neyt; Hac�yanl�, Mehmet; S�zen, Emin Cem; �nal, Ahmet; F�z�n, Mehmet

Cilt : 4 Say� : 1 Y�l : 2024

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H�zl� Arama

HARTMANN ��LEM�: �LK TERC�H M�, SON �AREM�? [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 1998; 4(1): 76-80

HARTMANN ��LEM�: �LK TERC�H M�, SON �AREM�?

Selman S�kmen¹, C�neyt Bekta�er¹, Mehmet Hac�yanl�¹, Emin Cem S�zen¹, Ahmet �nal¹, Mehmet F�z�n¹
Dokuz Eyl�l �niversitesi T�p Fak�ltesi Genel Cerrahi Ad

Hartmann i�lemi, primer anastomozun g�venilir olmad�� sigmoid ve rektumun �st kesimini i�eren, de�i�ik patolojiler endikasyonu olan bir giri�imdir. �al��mam�zda Dokuz Eyl�l �niversitesi Hastanesi'nde 1992-1997 aras�nda Hartmann i�lemi yap�lan 31 hastadaki deneyimimiz incelenmi�tir. Hastalar�n 16's� erkek, 15'i kad�n olup ortalama ya� 65 (32-88)'ti. Hastalar�n 27'si (%87,1) acil, 4'� (%12,9) efektif �artlarda opere edilmi� olup 19'unda (%61,3) benign, 12'sinde (%38,7) malign patolojiler mevcuttu. Bu hastalar�n 17'sinde (%62,9), ortalama 86 (54-300) g�n sonra anastomoz yap�larak devaml�l�k sa�land�. Primer i�lemde mortalite %12,9; morbidite %29,3't�. Anastomoz yap�ld�ktan sonra ka�ak ve mortalite izlenmedi. �� hastada (%17,6) ba�ka nedenlere ba�l� morbidite geli�ti. Ge�mi�te vurgulanan rekonstr�ksiyon g��l��n�n belli oranda a��lmas� ve y�ksek seyreden morbidite ve mortalite oran�n�n giderek azalmas� nedeniyle Hartmann i�lemi, y�ksek riskli hastalarda s�ras�nda ilk tercih, s�ras�nda son �are olarak se�ilebilen bir y�ntemdir.

Anahtar Kelimeler: HARTMANN ��LEM�, KOLOSTOM� KAPATILMASI, KOMPL�KASYONLAR

HARTMANN'S PROCEDURE: FIRST CHOICE OR LAST RESORT?

Selman S�kmen¹, C�neyt Bekta�er¹, Mehmet Hac�yanl�¹, Emin Cem S�zen¹, Ahmet �nal¹, Mehmet F�z�n¹
Dokuz Eyl�l �niversitesi T�p Fak�ltesi Genel Cerrahi Ad

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 Eyl�l 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.

Keywords: HARTMANN'S PROCEDURE, COLOSTOMY CLOSURE, COMPLICATIONS

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