OBJECTIVE: There is ongoing controversy regarding the extent to which Hartmann\'s procedure (HP) should be used in rectal cancer treatment. This study was designed to investigate 30-day postoperative morbidity and mortality following HP, anterior resection (AR) and abdominoperineal resection (APR) for rectal cancer using a national registry.
METHODS: All patients operated for rectal cancer, tumour height 5-15 cm, between the years 2010 and 2017, were identified through the Swedish colorectal cancer registry.
RESULTS: A total of 8476 patients were included: 1210 (14%) undergoing HP, 5406 (64%) AR and 1860 (22%) APR. HP was associated with an increased risk of intra-abdominal infection (OR 1.7, CI 1.26-2.28, P = 0.0004) compared to AR and APR, while APR was related to an increased risk of overall complications (OR 1.18, CI 1.01-1.40, P = 0.040). No significant difference was observed in the rate of reoperations and readmissions between HP, AR and APR, and type of surgical procedure was not a risk factor for 30-day mortality. Findings from a subgroup analysis of patients with a tumour 5-7 cm from the anal verge revealed that HP was not associated with increased risk for complications or 30-day mortality.
CONCLUSIONS: For patients where AR is not appropriate HP is a valid alternative with a favourable outcome. APR was associated with the highest overall 30-day complication rate.

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.

Real-world data on outcomes following Hartmann\'s reversal is necessary to help optimize the patient experience. We have explored the timing between the index operation and its reversal; what investigations were carried out prior to this, and the associated short-term outcomes.
A retrospective study of all patients who underwent Hartmann\'s reversal from 2010 to 2020 within a tertiary referral centre in Melbourne, Australia. One hundred from a total of 406 (25%) who underwent an emergency Hartmann\'s procedure had a subsequent reversal. Complete patient data was available for 83 of these patients.
The average patient age was 60 years, and the median time for reversal was 14.0 (IQR 10-23) months. Seventy-nine of 83 (95%) reversals had a preoperative endoscopic evaluation of both their rectal stump and a complete colonoscopy. Stoma stenosis (n = 2), patient refusal (n = 1) and emergency reversal (n = 1) were cited reasons for not undergoing preoperative endoscopic evaluation. A third (n = 28, 34%) had a computed tomography prior to reversal; the majority was due to their underlying cancer surveillance (n = 21, 75%). Reversal was associated with a morbidity rate of 47% (n = 39). Surgical site infections (SSIs) (n = 21, 25%) were the most common type of complications encountered, with the majority being superficial (n = 15, 71%). SSIs were associated with steroid use (5/21 versus 4/62, p = 0.03) and greater hospital length of stay (6 versus 10 days, p = 0.03).
Only a quarter of emergency Hartmann\'s procedures within our institution were reversed. A significant proportion developed postoperative complications. Surgical site infection was the most common morbidity.

Functional complaints after colorectal surgery have a profound effect on quality of life (QoL). Our goal was to investigate the prevalence of functional complaints and quality of life after Hartmann\'s reversal surgery.
A cross-sectional study was performed where one hundred nineteen patients were included. All patients underwent Hartmann\'s reversal procedure between 2007 and 2019. All patients were asked to complete 3 validated questionnaires related to bowel function in benign and colorectal cancer surgery as well as general QoL.
The response rate was 67%. Among responders, 32.8% reported LARS-like symptoms whereas 25% had significant COREFO Scores (>15). Higher LARS and COREFO scores were significantly associated with worse global QoL and several QoL domain scores (p < 0.05).
This study highlights the prevalence of bowel dysfunction after Hartmann\'s reversal surgery. Patients undergoing this procedure show similar functional complaints compared to those in literature who had a resection without colostomy.

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: Functional dependence (FD) is associated with poor postoperative outcomes. We investigated the influence of FD on the postoperative outcomes of colectomy.
METHODS: The 2012-2020 National Surgical Quality Improvement Program was queried for patients who had undergone colectomy for diverticulitis. The patients were analyzed based on FD or functionally independent (FI) status.
RESULTS: Of the 62,409 patients 991 (1.6%) were FD. Compared to FI patients, those with FD were older (mean age, 72.7 vs. 59.1 years, p < 0.001), with higher comorbidities and more unplanned open procedures (79.7% vs. 38.0%, p < 0.001). After adjusting for American Society of Anesthesia status, age, and comorbidities, the FD patients were 1.12 times (95% CI:1.07-1.17) more likely to have postoperative morbidity and 1.53 times (95% CI: 1.2-1.82) more likely to have 30-day mortality.
CONCLUSIONS: Dependent functional status is an independent risk factor for complications after surgery for diverticulitis.

BACKGROUND: The aim of the present study is to present the three years follow-up a randomised controlled trial that compared Hartmann\'s Procedure (HP) with sigmoidectomy with primary anastomosis (with or without defunctioning ileostomy) (PA) in a randomised design to determine the optimal treatment strategy for perforated diverticulitis with purulent or fecal peritonitis.
METHODS: Data were prospectively gathered for the first 12 months after randomization and retrospectively collected up to 36 months. The primary long-term endpoint was stoma free rate 36 months after the index procedure. Secondary outcomes were patients with a stoma at 36 months, percentage of stoma reversals, related reinterventions, parastomal/incisional hernia rates, total in hospital days including all readmissions regardless their relation to the intervention, overall morbidity and mortality.
RESULTS: Three years follow-up was completed in 119 of the originally 130 included patients, with 57 (48%) in the PA-group and 62 (52%) patients in the HP-group. 36 months stoma free rate was significantly better for patients undergoing PA compared with HP (PA 92% vs HP 81%, hazard ratio 2.326 [95% CI 1.538-3.517]; log-rank p < 0·0001). Stoma reversal rates did not significantly differ (PA 31/40(78%) versus HP 45/61(74%), p = 0.814). Overall cumulative morbidity (PA 21/57(36%) versus HP 30/62(48%), p = 0.266) and mortality (PA 6/57(11%) versus HP 7/62 (11%), p = 1.000) did not differ between groups. However, more parastomal hernias occurred in the HP-group (HP 10/62(16%) vs PA 1/57(2%), p = 0.009) and the mean total in hospital days after three years follow-up was significantly lower in the PA-group compared to the HP-group (PA 14 days (IQR 9.5-22.5) versus HP 17 days (IQR 12.5-27.5)), p = 0.025).
CONCLUSIONS: Long-term results showed that in haemodynamically stable, immunocompetent patients primary anastomosis is superior to Hartmann\'s procedure as treatment for perforated diverticulitis with respect to long-term stoma free rate, overall hospitalization and parastomal hernias.

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.