Hartmann kolostomi kapatıldıktan sonraki klinik seyir

Öz

Amaç: Amacımız, Hartmann kolostomi kapatılan hastaların klinik seyirlerindeki olumsuz etmenleri değerlendirmekti. Gereç ve Yöntemler: 1 Ocak 2012-31 Aralık 2017 tarihleri arasında kliniğimizde Hartmann kolostomi kapatılan 66 hastanın demografik verileri, kolostomi açılma nedenleri, postoperatif yatış süreleri, yoğun bakım ihtiyacı, mortalite/morbidite varlığı, Amerikan Anesteziyoloji Derneği Skoru(ASA) ve komplikasyonları tanı/tedavi yaklaşımları ile ilgili veriler retrospektif olarak elektronik ortamdaki kayıtlarından elde edildi. Bulgular: 66 hastanın 46(%69)’sı erkek ve 20(%31)’si kadındı. Bunların medyan yaşları 54(18-85) idi. Çalışmaya dahil olan hastaların 21(%32)’i kolorektal kanser, 11(%17)’i sigmoid volvulus, 4(%6)’ü divertikülit perforasyonu ve geri kalan 30(%45) hasta diğer nedenlerle (12 hasta sigmoid volvulus, 2 hasta yüksek enerjili patlama ve 2 hasta iskemik kolit v.b.) Hartmann kolostomi açılmış hastalardı. Ostomilerin ortalama kapatma süreleri 4±3 aydı. ASA skoru 19(%28) hastada II ve 47(%72) hastada III’dü. 19(%28) hastada cerrahi alan enfeksiyonu ve 4(%6) hastada anastomoz kaçağı tespit edildi. Kaçak tespit edilen 1(%1,5) hastada postoparatif ilk 7 günde mortalite gelişti. Mortalite gelişen hastanın Charlson Comorbidity Index (CCI)’i 6 ve ölüm nedeni de pulmoner emboliydi. 6(%9) hastada postoperatif erken dönemde (ilk 7 gün) ileus gelişti. 7(%10) hastada postoperatif yoğun bakım ihtiyacı oldu. Hastaların postoperatif yatış süreleri ortalama±SD=15,11±9,12 gündü. Sonuç: Stoma kapanmasından sonraki morbidite ve mortalite önemsiz bir durum değildir. Hartmann prosedüründen sonra optimal kapatma intervali, uygun hasta seçimi, hastanın komorbidite yükü, merkezde yoğun bakım varlığı ve özelleşmiş veya deneyimli merkezlerde kapatılma işleminin yapılmasının uygun olacağını düşünmekteyiz.

Anahtar Kelimeler

• Hartmann prosedürü
• komplikasyon
• hartmann kolostomi kapatılması

Clinical course after Hartman colostomy closure

Öz

Aim: Our aim was to evaluate the adverse effects of clinical course of patients with Hartmann colostomy closure. Material and methods: Demographic data of 66 patients who had closed Hartmann colostomy at our clinic between January 1, 2012 and December 31, 2017, American Anesthesiology Association Score (ASA) and its complications / diagnosis and treatment approaches were retrospectively obtained from the electronic records. Results: Of the 66 patients, 46 (69%) were male and 20 (31%) were female. Their median age was 54 (18-85). 21 (32%) of the patients included colorectal cancer, 11 (17%) sigmoid volvulus, 4 (6%) diverticulitis perforation, and the remaining 30 (45%) patients for other reasons (12 patients sigmoid volvulus, 2 patients had high energy burst and 2 patients had ischemic colitis, etc. Hartmann colostomy was opened. The mean closure time of the ostomies was 4 ± 3 months. The ASA score was II in 19 (28%) and III in 47 (72%) patients. Surgical site infection was detected in 19 (28%) patients and anastomotic leak was detected in 4 (6%) patients. Mortality was observed in the first 7 days in 1 (1.5%) patient with leakage. The patient who developed mortality was Charlson Comorbidity Index (CCI) 6 and cause of death was pulmonary embolism. In 6 (9%) patients, ileus developed in the early postoperative period (first 7 days). 7 (10%) patients needed postoperative intensive care. The mean postoperative hospital stay was ± SD = 15,11 ± 9,12 days. Conclusion: The morbidity and mortality after stoma closure is not negligible. After the Hartmann procedure, we think that optimal closure interval, appropriate patient selection, patient's comorbidity load, intensive care unit at the center, and closure at specialized or experienced centers will be appropriate.

Anahtar Kelimeler

• Hartmann procedure
• complication
• hartmann colostomy closure

Kaynakça

1. 1. Roque-Castellano C, Marchena-Gomez J, Hemmersbach-Miller M et al. Analysis of the factors related to the decision of restoring intestinal continuity after Hartmann’s procedure. International journal of colorectal disease 2007; 22: 1091-6.
2. 2. Faure JP, Doucet C, Essique D et al. Comparison of conventional and laparoscopic Hartmann's procedure reversal. Surgical Laparoscopy Endoscopy & Percutaneous Techniques 2007; 17: 495-9.
3. 3. Toro A, Ardiri A, Mannino M et al. Laparoscopic reversal of Hartmann’s procedure: state of the art 20 years after the first reported case. Gastroenterology research and practice. 2014; 2014: 530140
4. 4. Cellini C, Deeb AP, Sharma A, Monson J, Fleming F. Association between operative approach and complications in patients undergoing Hartmann's reversal. British Journal of Surgery 2013; 100: 1094-9.
5. 5. Schmelzer TM, Mostafa G, Norton HJ et al. Reversal of Hartmann’s procedure: A high-risk operation? Surgery 2007; 142: 598-607.
6. 6. van de Wall BJM, Draaisma WA, Schouten ES, Broeders IA, Consten EC. Conventional and laparoscopic reversal of the Hartmann procedure: a review of literature. Journal of Gastrointestinal Surgery 2010; 14: 743-52.
7. 7. Maggard MA, Zingmond D, O'Connell JB, Ko CY. What proportion of patients with an ostomy (for diverticulitis) get reversed? The American surgeon 2004; 70: 928.
8. 8. Vermeulen J, Gosselink MP, Busschbach JJ, Lange JF. Avoiding or reversing Hartmann’s procedure provides improved quality of life after perforated diverticulitis. Journal of Gastrointestinal Surgery 2010; 14: 651-7.

9. 9. Horesh N, Lessing Y, Rudnicki Y et al. Considerations for Hartmann’s reversal and Hartmann’s reversal outcomes—a multicenter study. International journal of colorectal disease 2017; 32: 1577-82.
10. 10. Roig J, Cantos M, Balciscueta Z et al. Hartmann’s operation: how often is it reversed and at what cost? A multicentre study. Colorectal Disease 2011; 13: 396-402.
11. 11. Fleming FJ, Gillen P. Reversal of Hartmann’s procedure following acute diverticulitis: is timing everything? International journal of colorectal disease 2009; 24: 1219-25.
12. 12. Antolovic D, Reissfelder C, Özkan T et al. Restoration of intestinal continuity after Hartmann's procedure—not a benign operation. Are there predictors for morbidity? Langenbeck's archives of surgery 2011; 396: 989-96.
13. 13. Richards C, Roxburgh C, Group SSR. Surgical outcome in patients undergoing reversal of Hartmann's procedures: a multicentre study. Colorectal Disease 2015; 17: 242-9.
14. 14. Zarnescu E, Zarnescu N, Costea R, Rahau L, Neagu S. Morbidity after reversal of Hartmann operation: retrospective analysis of 56 patients. Journal of medicine and life 2015; 8: 488.
15. 15. Fonseca AZ, Uramoto E, Santos-Rosa OM, Santin S, Ribeiro-Jr M. Colostomy closure: risk factors for complications. ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) 2017; 30: 231-4.
16. 16. Geng HZ, Nasier D, Liu B, Gao H, Xu YK. Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma. The Annals of The Royal College of Surgeons of England 2015; 97: 494-501.