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Considerations When Performing Hartmann’s Operation Performed as the First Stage of Two-stage Surgery for Ulcerative Colitis with Findings Indicate Residual Proctectomy in the Second Stage

Kuroki, Hirosuke ; Sugita, Akira ; Koganei, Kazutaka ; Tatsumi, Kenji ; Futatsuki, Ryo ; Yamada, Kyoko ; Arai, Katsuhiko ; Fukushima, Tsuneo

The Japanese Journal of Gastroenterological Surgery, 2015/11/01, Vol.48(11), pp.883-889

The Japanese Society of Gastroenterological Surgery

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  • Título:
    Considerations When Performing Hartmann’s Operation Performed as the First Stage of Two-stage Surgery for Ulcerative Colitis with Findings Indicate Residual Proctectomy in the Second Stage
  • Autor: Kuroki, Hirosuke ; Sugita, Akira ; Koganei, Kazutaka ; Tatsumi, Kenji ; Futatsuki, Ryo ; Yamada, Kyoko ; Arai, Katsuhiko ; Fukushima, Tsuneo
  • Assuntos: Hartmann’s operation ; staged operation ; ulcerative colitis
  • É parte de: The Japanese Journal of Gastroenterological Surgery, 2015/11/01, Vol.48(11), pp.883-889
  • Descrição: Purpose: Considerations in the first-stage surgery were evaluated based on problems encountered anticipated during residual proctectomy in the second stage of ulcerative colitis. Patients and methods: Twenty-three patients who underwent total/subtotal colectomy and Hartmann’s operation in a two-stage procedure were classified into high- and low-level groups with a rectal stump above and below the peritoneal reflection, respectively. Results: In the second stage, all 17 patients in the high-level group underwent ileal pouch-anal canal anastomosis, while 4, 1, and 1 in the low-level group (n=6) underwent ileal pouch-anal canal anastomosis, ileal pouch-anal anastomosis, and ileal pouch-rectal anastomosis, respectively. The median operative time and blood loss were 212 min and 370 ml and 344 min and 983 ml in the high- and low-level groups, respectively, indicating that blood loss was significantly greater (P=0.04) and the operative time tended to be longer (P=0.26) in the low-level group. The mean number of stools per day 1 year after the second-stage operation was 6.4 and 7.5 in the high- and low-level groups, respectively. Conclusion: Rectal transection below the peritoneal reflection in Hartmann’s operation results in firm adhesions of the rectal stump to the surrounding tissue, such as the seminal vesicle, leading to excessive bleeding due to difficult adhesiolysis, thus prolonging the operative time. These results suggest that the rectum should be transected above the peritoneal reflection when performing Hartmann’s operation as the first stage.
  • Editor: The Japanese Society of Gastroenterological Surgery
  • Idioma: Japonês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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