Problems during hartmann’s reconstruction

Abstract

Reversal of a Hartmann’s resection is often challenging and requires planning, and the assessment of the rectal stump is dependent upon the original indication for the nonrestorative procedure. The reported complication rate after Hartmann’s reconstruction is high, with morbidity rates of 30–40 %, anastomotic leakage rates as high as 15 %, and a reported mortality of up to 10 %. Advanced age and multiple comorbid conditions in a large proportion of patients who recover after Hartmann’s procedure further discourages both surgeons and patients from sometimes opting for reconstruction; 40 % of patients undergoing Hartmann’s resection never have stoma reversal. In this chapter, the technical aspects of Hartmann’s reconstruction are discussed, operative tips are provided, and the selective use of a laparoscopic-assisted approach is considered. © Springer-Verlag London 2013.