TPW 2.02 Timing of Reversal after Hartmann Procedure for benign indication and Its Impact on Outcomes: A Systematic Review

Abstract

Hartmann’s Procedure (HP) is commonly performed for various indications. The optimal interval between index procedure and stoma reversal remains uncertain. Surgeons balance risks of operative difficulty and complications against the prolonged stoma morbidities. A systematic review of 7 studies was conducted. Studies comparing different reversal intervals were included. Primary outcomes were overall morbidity. Secondary outcomes included anastomotic leak, mortality, reoperation, readmission, and stoma-free survival. 7 studies involving 2622 patients who underwent stoma reversal following HP for benign causes were included. Across the studies, “early” reversal was commonly defined as early as 45 days to 6 months after index surgery, and “delayed” as beyond that threshold. Early reversal was associated with reduced length of stay. Overall complication rates were similar or lower with early reversal in most series. Major complications and anastomotic leak were low overall and did not show a consistent increase with early reversal when patients were clinically optimized. Delayed reversal correlated with older age, higher comorbidity burden, pelvic sepsis at index surgery, and difficult abdominopelvic planes. Smoking, diabetes and chronic kidney disease were repeatedly identified as predictors of postoperative morbidity following reversal. However, definitions of “early” reversal vary, for appropriately selected and optimized patients, reversal within 45 days to 6 months, as evidenced, is as safe as later reversal and could potentially improve recovery metrics and stoma-free time. Patient factors and individual operative expertise should guide individual timing decisions.