Early Colostomy Reversal May Improve Outcomes

A new study suggests that in selected patients, colostomy closure following the Hartmann procedure for diverticulitis is safe as early as 45 days after the initial procedure.

Researchers at Yale School of Medicine (New Haven, CT, USA) conducted a retrospective analysis of inpatient databases for California, Florida, and Maryland in order to explore the association between colostomy reversal timing and operative outcomes in 1,660 patients (51.8% men, median age 61 years) who underwent the Hartmann procedure for diverticulitis. The patients were divided based on timing of colostomy reversal following the index surgery into early (45-110 days), middle (111-169 days), and late (≥170 days). Patients with readmissions between the index surgery and reversal were excluded.

The results revealed that the median time to reversal was 129 days. Patient characteristics associated with early reversal included being 60 years or younger, white, and having private insurance (compared to Medicaid). Mortality, transfusion, presence of ileus, and major complications were not significantly different among groups. However, prolonged length of stay and 90-day readmission was significantly more likely in the late timing groups. The study was published on November 21, 2018, in JAMA Surgery.

“Less than one-third of patients undergo colostomy reversal within one year after end colostomy for diverticulitis, and reversal timing is associated with socioeconomic disparities,” concluded senior author Kevin Pei, MD, and colleagues. “In selected patients with an uncomplicated course, improved outcomes are associated with earlier reversal, and colostomy reversal is safe as early as 45 to 110 days after the initial procedure.”

Hartmann's procedure, or proctosigmoidectomy, involves surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of a colostomy. It is the most common operation carried out by general surgeons for management of malignant obstruction of the distal colon. During the procedure, the lesion is removed, the distal bowel closed intraperitoneally, and the proximal bowel diverted with a stoma. The procedure is named after French surgeon Henri Albert Hartmann, who first described it in 1921.

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