Validity of the Hartmann operation in the treatment of complicated colonic diverticulosis: study carried out in patients treated during the period 2009-2018, at Hospital de Clínicas, Montevideo
Vigencia de la operación de Hartmann en el tratamiento de la diverticulosis colónica complicada: estudio realizado en pacientes tratados durante el periodo 2009-2018, en Hospital de Clínicas de Montevideo
Resumen:
Introduction and objectives: Complicated diverticular disease is a health problem that affects elderly patients and often requires surgical treatment. Options are multiple, being Hartmann procedure an old and still valid alternative. The objective of the present study was to evaluate the validity of this procedure in our environment through an analytical study of a population in a University Hospital of Montevideo.Materials and methods: Analyze the medical records of patients older than 20 years operated on in the period 2009-2018. Consider the following variables: surgical procedures, peri-operative complications, re-treatments, rate and time of reconstruction of the digestive transit and mortality.Results: 27 patients were operated in the analyzed period, with a mean age of 59.4 years. In 15 of them, a Hartmann procedure was performed. In the remaining patients, procedures performed were approach both ends, primary anastomosis with or without a proximal stoma, and assisted video washing and drainage without resection. Eleven patients (40%) presented peri-operative complications. Peri-operative mortality was four patients (14.8%), all corresponding to Hartmann's operation. The recovery rate was six of 11 surviving patients.Discussion: The Hartmann operation maintains the validity and the most used procedure, being its considerable morbidity and mortality and the recovery rate of approximately half of the patients. The primary anastomosis should be reserved for selected cases. The development of laparoscopic surgery has also allowed conservative procedures, such as washing and drainage, avoiding acute resection, this option being a growing trend.Conclusions: It was concluded that the series, although short, reproduce what was reviewed in the bibliography.
Introducción y objetivos: La enfermedad diverticular complicada constituye un problema de salud que afecta a pacientes añosos y muchas veces requiere tratamiento quirúrgico. Las opciones son múltiples, siendo la operación de Hartmann una alternativa antigua y aún vigente. El objetivo del presente estudio fue evaluar la vigencia de dicha intervención en nuestro medio a través del estudio analítico de una población en un Hospital universitario de Montevideo.Materiales y métodos: Se analizaron las historias clínicas de los pacientes mayores de 20 años operados en el período 2009-2018. Se consideraron las siguientes variables: procedimientos quirúrgicos, complicaciones peri operatorias, re intervenciones, tasa y tiempo de reconstrucción del tránsito digestivo y mortalidad.Resultados: El número total de pacientes operados en el período analizado fue de 27, con una media de edad de 59,4 años. En 15 de ellos se realizó un procedimiento de Hartmann, En los restantes pacientes los procedimientos realizados fueron abocamiento de ambos cabos, anastomosis primaria con y sin estoma proximal y lavado y drenaje video-asistido sin resección. Presentaron complicaciones peri operatorias 11 pacientes (40 %). La mortalidad peri operatoria fue de cuatro pacientes (14.8 %), correspondiendo todos a la operación de Hartmann. La tasa de reconstrucción fue seis de 11 pacientes sobrevivientes.Discusión: La operación de Hartmann mantiene vigencia y es el procedimiento más utilizado, siendo su morbimortalidad considerable y la tasa de reconstrucción de aproximadamente la mitad de los pacientes. La anastomosis primaria debe ser reservada para casos seleccionados. El desarrollo de la cirugía laparoscopia también ha permitido procedimientos conservadores, como el lavado y drenaje, evitando la resección en agudo, siendo esta opción una tendencia creciente.Conclusiones: Se concluyó que la serie, si bien corta, reproduce lo revisado en la bibliografía.
2021 | |
diverticulosis colónica operación de Hartmann clasificación de Hinchey colostomía reconstrucción colonic diverticulosis Hartmann's operation Hinchey's classification colostomy reconstruction |
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Español | |
Sociedad de Cirugía del Uruguay | |
Revista Cirugía del Uruguay | |
https://revista.scu.org.uy/index.php/cir_urug/article/view/3264 | |
Acceso abierto |
Sumario: | Introduction and objectives: Complicated diverticular disease is a health problem that affects elderly patients and often requires surgical treatment. Options are multiple, being Hartmann procedure an old and still valid alternative. The objective of the present study was to evaluate the validity of this procedure in our environment through an analytical study of a population in a University Hospital of Montevideo.Materials and methods: Analyze the medical records of patients older than 20 years operated on in the period 2009-2018. Consider the following variables: surgical procedures, peri-operative complications, re-treatments, rate and time of reconstruction of the digestive transit and mortality.Results: 27 patients were operated in the analyzed period, with a mean age of 59.4 years. In 15 of them, a Hartmann procedure was performed. In the remaining patients, procedures performed were approach both ends, primary anastomosis with or without a proximal stoma, and assisted video washing and drainage without resection. Eleven patients (40%) presented peri-operative complications. Peri-operative mortality was four patients (14.8%), all corresponding to Hartmann's operation. The recovery rate was six of 11 surviving patients.Discussion: The Hartmann operation maintains the validity and the most used procedure, being its considerable morbidity and mortality and the recovery rate of approximately half of the patients. The primary anastomosis should be reserved for selected cases. The development of laparoscopic surgery has also allowed conservative procedures, such as washing and drainage, avoiding acute resection, this option being a growing trend.Conclusions: It was concluded that the series, although short, reproduce what was reviewed in the bibliography. |
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