UNASSIGNED: Gangrenous sigmoid volvulus has a significant impact on morbidity and mortality. This study was conducted to compare sigmoid resection and primary anastomosis (RPA) with sigmoid resection and end colostomy (Hartmann\'s procedure) for gangrenous sigmoid volvulus.
UNASSIGNED: A systematic review and meta-analysis study design was employed to summarize retrospective cohort, prospective cohort, and randomised control trial studies published from inception to march 31, 2023. Searching was performed on Medline, CINAHAL, Web of Science, Google Scholar, the Cochrane Library, and ClinicalTrials.gov to locate eligible articles. Data searching, selection and screening, quality assessment of the included articles, and data extraction were done by two separate reviewers. RevMan 5.4 software with a fixed-effect Mantel-Haenszel model and Stata version 14 were used to analyze the data. The protocol registered on PROSPERO registration website (CRD42023413367).
UNASSIGNED: Ten cohort studies and one randomised control trial with 724 patients were found; all of them were rated as being of moderate quality. The overall mortality after RPA was 15% (95%CI: 11-19%), and after Hartmann\'s procedure it was 19% (95%CI: 15-23%). Resection and primary anastomosis (RPA) for gangrenous sigmoid volvulus had slightly lower mortality rate than stoma (OR=0.98(95%CI: 0.68-1.42), p=0.07, I2=43%), which had no statistically significant difference. Resection and primary anastomosis (RPA) had a slightly higher morbidity rate than Hartmann\'s procedure (OR=1.01(95%CI: 0.66-1.55), p=0.30, I2=18%), which had no statistically significant difference.
UNASSIGNED: Sigmoid resection and primary anastomosis (RPA) and Hartmann\'s procedure had no significant differences in mortality and morbidity for the treatment of gangrenous sigmoid volvulus. Choice of the intervention for gangrenous sigmoid volvulus should be individualized with consideration of different detrimental factors.

Diverticulitis is a common indication for colorectal surgery, both in the acute and the elective setting. The anastomosis between the colon and rectum is a critical component of colectomy for diverticular disease and should be approached thoughtfully. This article reviews important surgical considerations when creating a colorectal anastomosis in the setting of diverticular disease, whether following the reversal of an end colostomy, during an acute episode of diverticulitis, or electively for chronic or complicated disease. Timing of surgery and preoperative assessment, minimally invasive approaches, and intraoperative maneuvers and considerations are discussed.

Sigmoid volvulus is a common cause of colon obstruction, while volvulus of the transverse colon rarely causes bowel obstruction. The occurrence of transverse colon volvulus after resection of the sigmoid colon volvulus is extremely rare. This report presents a 73-year-old man who presented with abdominal pain and peritonitis. The patient underwent exploratory laparotomy, and sigmoid volvulus and cecum perforation were confirmed. A right hemicolectomy, end-to-side ileotransverse colon anastomosis for the cecal perforation, and sigmoidectomy with end-colostomy (Hartmann\'s procedure) for the sigmoid volvulus were performed. A month later, the patient returned to the emergency room with abdominal distention and the blockage of colostomy. Abdominal CT revealed a transverse colon volvulus. A transverse and descending colon resection and ileorectal anastomosis were performed. The patient\'s condition was stable at the time of discharge from the hospital. The management of metachronous colon volvulus should include surgical intervention. If patients are not diagnosed immediately, their condition may deteriorate dramatically because of bowel infarction or peritonitis. It is essential to highlight this case, as many surgeons may not have attended a transverse colon volvulus after sigmoid volvulus, which might lead to high morbidity or mortality. Overall, metachronous colonic volvulus must be considered in the differential diagnosis of bowel obstruction, particularly in patients with significant risk factors.
الانفتال السيني هو سبب شائع لانسداد القولون، بينما نادرا ما يتسبب انفتال القولون المستعرض في انسداد الأمعاء. ومن النادر للغاية حدوث انفتال القولون المستعرض بعد استئصال انفتال القولون السيني. يقدم هذا التقرير رجلا يبلغ من العمر ٧٣ عاما يعاني من آلام البطن والتهاب الصفاق. خضع المريض لبضع البطن الاستكشافي وتم التأكد من التواء القولون السيني وانثقاب الأعور. وتم إجراء استئصال النصف الأيمن للقولون، ومفاغرة القولون اللفائفي العرضي من طرف إلى جانب الانثقاب الأعور، واستئصال السيني مع فغر نهاية القولون (إجراء هارتمان) للانفتال السيني. بعد شهر، عاد المريض إلى الطوارئ يشتكي من انتفاخ في البطن وانسداد في فغر القولون. وكشف التصوير المقطعي المحوسب للبطن عن انفتال القولون المستعرض. تم استئصال القولون المستعرض والنازل ومفاغرة اللفائفي المستقيم. وخرج المريض من المستشفى في حالة مستقرة. يجب أن تشمل إدارة انفتال القولون متغير الزمن التدخل الجراحي. إذا لم يتم تشخيص المرضى على الفور، فقد تدهور حالتهم بشكل كبير بسبب احتشاء الأمعاء أو التهاب الصفاق. ومن الضروري تسليط الضوء على هذه الحالة لأن الكثير من الجراحين ربما لم يعالجوا انفتال القولون المستعرض بعد الانفتال السيني، مما قد يؤدي إلى ارتفاع معدلات المراضة أو الوفاة. بشكل عام، يجب مراعاة الانفتال القولوني المتغير الزمن في التشخيص التفريقي لانسداد الأمعاء، خاصة في المرضى الذين يعانون من عوامل خطر كبيرة.

BACKGROUND: Laparoscopic Hartmann\'s reversal (LHR) has recently been reported to be safer and more feasible than open Hartmann\'s reversal (OHR); however, there is limited data on the outcomes of LHR compared with those of OHR from Asian countries. Therefore, we aimed to clarify the postoperative outcomes of LHR compared with OHR, and additionally compare the patient outcomes post-LHR according to the previous Hartmann\'s procedure (HP) approach.
METHODS: Patients who underwent OHR and LHR between January 2006 and September 2020 in a single center in Japan, were retrospectively evaluated. Patient characteristics and perioperative data were collected from the medical and surgical records and assessed.
RESULTS: Overall, 15 and 19 patients underwent OHR and LHR, respectively, between January 2006 and September 2020. LHR was associated with less blood loss (median: 15 mL vs 185 mL; P < .001) and shorter hospital stays (9 days vs 14 days; P = .023) than OHR. There was no significant difference in postoperative complications between LHR and OHR (26.3% vs 40.0%, P = .475). However, two severe anastomotic complications in LHR were observed in patients with the stump below the peritoneal reflection. No significant difference in outcomes was observed between LHR patients who underwent open and laparoscopic HP.
CONCLUSIONS: LHR resulted in positive outcomes regarding estimated blood loss and postoperative hospitalization, compared with OHR. Although the postoperative complications between LHR and OHR were not significant, patients with the stump below the peritoneal reflection may be at a high risk of anastomotic complications.

BACKGROUND: The Hartmann procedure is currently recognized as a common, safe, and feasible surgical procedure. However, its reversal rate is low, and the optimal timing for Hartmann reversal surgery is controversial.
METHODS: A 65-year-old man came to our hospital with a complaint of an intestinal fistula next to the stoma. The patient had undergone a Hartmann procedure 13 years prior. We performed colonoscopy, computed tomography, and other diagnostics before successfully reversing the stoma.
CONCLUSIONS: Although the optimal time for Hartmann procedure reversal is controversial, time may ultimately not be a factor in the success of reversal.

UNASSIGNED: The aim of this study is to compare the short outcomes of two methods of sigmoid resection and primary anastomosis with sigmoid resection and end colostomy (Hartmann\'s procedure) for sigmoid volvulus.
UNASSIGNED: This retrospective study included 102, of which 56 patients underwent end colostomy (Hartmann\'s procedure) and 46 patients underwent resection and primary anastomosis for sigmoid volvulus. The medical records of the patients were reviewed to evaluate the patients\' characteristics, operative data, short-term postoperative outcomes and mortality.
UNASSIGNED: The mean age of patients in the groups of Hartmann\'s procedure and primary anastomosis were 68.23 ± 13.42 and 70.10 ± 12.71, respectively. From the 46 patients who had primary colorectal anastomosis, 2 patients (4.3%) suffered from anastomosis leakage, which was not significantly different. This study showed that anastomosis leakage, prolonged ileus, bleeding, surgical site infection and fascial dehiscence were not different between Hartmann\'s procedure and primary anastomosis, significantly, p < 0.05. Hospital stay in the Hartmann group was less than primary anastomosis group in the same admission, p = 0.04. The mortality rate was not statistically different among the two groups, p = 0.549.
UNASSIGNED: Postoperative complications and mortality rate do not different among the two groups however, the duration of hospitalization was lesser in Hartmann\'s procedure group.

OBJECTIVE: The current study aimed to identify the safety and efficacy of Hartmann\'s procedure (HP) among elderly patients (age ≥80 years) with rectal cancer.
METHODS: Data on surgical outcome, survival rate, and incidence of stoma reversal were retrospectively compared between patients aged over 80 years who underwent anterior resection (AR) and HP.
RESULTS: In total, 79 elderly patients underwent rectal cancer surgery. Of these patients, 54 (68.4%) underwent AR and 25 (31.6%) HP. The two groups did not differ significantly in terms of age, nutrient status, and tumor characteristics. Eight (14.8%) patients who underwent AR and six (24.0%) who underwent HP presented with intra-abdominal complications (p=0.35). The overall survival and recurrent-free survival rates between the two groups did not differ.
CONCLUSIONS: HP for elderly patients with rectal cancer has similar complication rates to AR, and achieved similar oncological outcomes.

Laparoscopic Hartmann\'s reversal (HR) is a major abdominal operation that is associated with considerable morbidity and mortality. The robotic approach, with its intrinsic advantages, could potentially overcome the technical complexity of laparoscopy. The aim of this study was to evaluate the short-term results of a series of 24 robotic HR cases.
The data from 24 patients who underwent robotic HR between September 2016 and July 2019 at two different institutions were prospectively collected and retrospectively analysed. A full robotic single-docking reversal procedure with intracorporeal anastomosis was performed in all patients.
The mean age and body mass index of the patients were 69 years and 26 kg/m2 , respectively. Of the patients, 58% were ≥ 70 years old and 42% had comorbidities (mean Charlson Comorbidity Index 3). The mean operating time was 240 min. There were no cases of conversion to the open or laparoscopic approach. No diverting loop ileostomies were constructed. The mean length of hospital stay was 6 days. Minor complications were recorded in three patients. Neither major complications nor 30-day readmissions were registered.
Robotic HR is a feasible and safe procedure. The robotic approach has low rates of major complications and conversion and could potentially increase the number of patients undergoing HR.

UNASSIGNED: Hartmann\'s procedure is a well-established alternative in colorectal surgery when a primary anastomosis is contraindicated. However, the rectal remnant may cause complications. This study was designed to investigate the occurrence of pelvic sepsis after Hartmann\'s procedure and identify possible risk factors.
UNASSIGNED: All patients who underwent Hartmann\'s procedure between 2005 and 2012 were identified by the in-hospital registry. Information about pelvic sepsis and potential preoperative, perioperative, and postoperative risk factors was obtained by review of the medical records.
UNASSIGNED: 172 patients were identified (97 females); they were aged 74 ± 11 years. Surgery was performed due to cancer (49%) or diverticulitis (35%) and other benign disease (16%). Rectal transection was carried out anywhere between the pelvic floor and the promontory. Pelvic sepsis developed in 6.4% (11/172) of patients. Pelvic sepsis was associated with preoperative radiotherapy (p = 0.03) and Hinchey grade III and IV (p = 0.02) in those patients who underwent Hartmann\'s procedure for diverticular disease.
UNASSIGNED: Hartmann\'s procedure is a safe operation when an anastomosis is contraindicated since the incidence of pelvic sepsis is low. Preoperative radiotherapy and Hinchey grade III and IV may be risk factors for the development of pelvic sepsis.

Aim of the study was to describe characteristics and outcomes of Hartmann\'s procedure (HP) and subsequent intestinal restoration.
Retrospective study including all patients who underwent HP over a period of 16 consecutive years. We propose a classification and regression tree for a more accurate view of the relationship between the variables related to intestinal restoration and their weighting in the decision to reverse HP.
533 patients were included. Overall morbidity rate of HP was 53.5% and mortality 21.0%. Overall morbidity of the intestinal continuity reconstruction was 47.3% and mortality 0.9%. Patients with a benign disease, aged under 69 years and with low comorbidity, had an 84.4% probability of undergoing intestinal reconstruction.
HP is associated with high morbidity and mortality. Restoration of intestinal continuity involves minor, but frequent, morbidity and a low mortality rate. Age and comorbidities can decrease, and even override, the decision to reverse HP.