World Journal of Emergency Surgery (Apr 2024)

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

  • Gennaro Perrone,
  • Mario Giuffrida,
  • Fikri Abu-Zidan,
  • Vitor F. Kruger,
  • Marco Livrini,
  • Gabriele Luciano Petracca,
  • Giorgio Rossi,
  • Antonio Tarasconi,
  • Brian W. C. A. Tian,
  • Elena Bonati,
  • Ricardo Mentz,
  • Federico N. Mazzini,
  • Juan P. Campana,
  • Elisabeth Gasser,
  • Reinhold Kafka-Ritsch,
  • Daniel M. Felsenreich,
  • Christopher Dawoud,
  • Stefan Riss,
  • Carlos Augusto Gomes,
  • Felipe Couto Gomes,
  • Ricardo Alessandro Teixeira Gonzaga,
  • Cassio Alfred Brattig Canton,
  • Bruno Monteiro Pereira,
  • Gustavo P. Fraga,
  • Leticia Gonçalves Zem,
  • Vinicius Cordeiro-Fonseca,
  • Renato de Mesquita Tauil,
  • Boyko Atanasov,
  • Nikolay Belev,
  • Nikola Kovachev,
  • L. Juan José Meléndez,
  • Ana Dimova,
  • Stefan Dimov,
  • Zdravko Zelić,
  • Goran Augustin,
  • Branko Bogdanić,
  • Trpimir Morić,
  • Elie Chouillard,
  • Melinda Bajul,
  • Belinda De Simone,
  • Yves Panis,
  • Francesco Esposito,
  • Margherita Notarnicola,
  • Lelde Lauka,
  • Anna Fabbri,
  • Hassen Hentati,
  • Iskander Fnaiech,
  • Venara Aurélien,
  • Marie Bougard,
  • Maxime Roulet,
  • Zaza Demetrashvili,
  • Irakli Pipia,
  • Giorgi Merabishvili,
  • Konstantinos Bouliaris,
  • Georgios Koukoulis,
  • Christos Doudakmanis,
  • Sofia Xenaki,
  • Emmanuel Chrysos,
  • Stamatios Kokkinakis,
  • Panteleimon Vassiliu,
  • Nikolaos Michalopoulos,
  • Ioannis Margaris,
  • Aristotelis Kechagias,
  • Konstantinos Avgerinos,
  • Jevgeni Katunin,
  • Eftychios Lostoridis,
  • Eleni-Aikaterini Nagorni,
  • Antonio Pujante,
  • Francesk Mulita,
  • Ioannis Maroulis,
  • Michail Vailas,
  • Athanasios Marinis,
  • Ioannis Siannis,
  • Eirini Bourbouteli,
  • Dimitrios K. Manatakis,
  • Nikolaos Tasis,
  • Vasileios Acheimastos,
  • Sotiropoulou Maria,
  • Kapiris Stylianos,
  • Harilaos Kuzeridis,
  • Dimitrios Korkolis,
  • Evangelos Fradelos,
  • George Kavalieratos,
  • Thalia Petropoulou,
  • Andreas Polydorou,
  • Ioannis Papacostantinou,
  • Tania Triantafyllou,
  • Despina Kimpizi,
  • Dimitrios Theodorou,
  • Konstantinos Toutouzas,
  • Alexandros Chamzin,
  • Maximos Frountzas,
  • Dimitrios Schizas,
  • Ioannis Karavokyros,
  • Athanasios Syllaios,
  • Alexandros Charalabopoulos,
  • Maria Boura,
  • Efstratia Baili,
  • Orestis Ioannidis,
  • Lydia Loutzidou,
  • Elissavet Anestiadou,
  • Ioannis Tsouknidas,
  • Georgios Petrakis,
  • Eleni Polenta,
  • Lovenish Bains,
  • Rahul Gupta,
  • Sudhir K. Singh,
  • Archana Khanduri,
  • Miklosh Bala,
  • Asaf Kedar,
  • Marcello Pisano,
  • Mauro Podda,
  • Adolfo Pisanu,
  • Gennaro Martines,
  • Giuseppe Trigiante,
  • Giuliano Lantone,
  • Antonino Agrusa,
  • Giuseppe Di Buono,
  • Salvatore Buscemi,
  • Massimiliano Veroux,
  • Rossella Gioco,
  • Gastone Veroux,
  • Luigi Oragano,
  • Sandro Zonta,
  • Federico Lovisetto,
  • Carlo V. Feo,
  • Antonio Pesce,
  • Nicolò Fabbri,
  • Giulio Lantone,
  • Fabio Marino,
  • Fabrizio Perrone,
  • Leonardo Vincenti,
  • Vincenzo Papagni,
  • Arcangelo Picciariello,
  • Stefano Rossi,
  • Biagio Picardi,
  • Simone Rossi Del Monte,
  • Diego Visconti,
  • Giulia Osella,
  • Luca Petruzzelli,
  • Giusto Pignata,
  • Jacopo Andreuccetti,
  • Rossella D’Alessio,
  • Massimo Buonfantino,
  • Eleonora Guaitoli,
  • Stefano Spinelli,
  • Gianluca Matteo Sampietro,
  • Carlo Corbellini,
  • Leonardo Lorusso,
  • Alice Frontali,
  • Isabella Pezzoli,
  • Alessandro Bonomi,
  • Andrea Chierici,
  • Christian Cotsoglou,
  • Giuseppe Manca,
  • Antonella Delvecchio,
  • Nicola Musa,
  • Massimiliano Casati,
  • Laface Letizia,
  • Emmanuele Abate,
  • Giorgio Ercolani,
  • Fabrizio D’Acapito,
  • Leonardo Solaini,
  • Gianluca Guercioni,
  • Simone Cicconi,
  • Diego Sasia,
  • Felice Borghi,
  • Giorgio Giraudo,
  • Giuseppe Sena,
  • Pasquale Castaldo,
  • Eugenia Cardamone,
  • Giuseppe Portale,
  • Matteo Zuin,
  • Ylenia Spolverato,
  • Marialusia Esposito,
  • Roberta Maria Isernia,
  • Maria Di Salvo,
  • Romina Manunza,
  • Giuseppe Esposito,
  • Marcello Agus,
  • Emanuele Luigi Giuseppe Asti,
  • Daniele Tiziano Bernardi,
  • Tommaso Panici Tonucci,
  • Davide Luppi,
  • Massimiliano Casadei,
  • Stefano Bonilauri,
  • Angela Pezzolla,
  • Annunziata Panebianco,
  • Rita Laforgia,
  • Maurizio De Luca,
  • Monica Zese,
  • Dario Parini,
  • Elio Jovine,
  • Giuseppina De Sario,
  • Raffaele Lombardi,
  • Giovanni Aprea,
  • Giuseppe Palomba,
  • Marianna Capuano,
  • Giulio Argenio,
  • Gianluca Orio,
  • Mariano Fortunato Armellino,
  • Marina Troian,
  • Martina Guerra,
  • Carlo Nagliati,
  • Alan Biloslavo,
  • Paola Germani,
  • Giada Aizza,
  • Igor Monsellato,
  • Ali Chaouki Chahrour,
  • Gabriele Anania,
  • Cristina Bombardini,
  • Francesco Bagolini,
  • Gabriele Sganga,
  • Pietro Fransvea,
  • Valentina Bianchi,
  • Paolo Boati,
  • Francesco Ferrara,
  • Francesco Palmieri,
  • Pasquale Cianci,
  • Domenico Gattulli,
  • Enrico Restini,
  • Nicola Cillara,
  • Alessandro Cannavera,
  • Gabriela Elisa Nita,
  • Jlenia Sarnari,
  • Francesco Roscio,
  • Federico Clerici,
  • Ildo Scandroglio,
  • Stefano Berti,
  • Alessandro Cadeo,
  • Alice Filippelli,
  • Luigi Conti,
  • Carmine Grassi,
  • Gaetano Maria Cattaneo,
  • Marina Pighin,
  • Davide Papis,
  • Giovanni Gambino,
  • Vanessa Bertino,
  • Domenico Schifano,
  • Daniela Prando,
  • Luisella Fogato,
  • Fabio Cavallo,
  • Luca Ansaloni,
  • Roberto Picheo,
  • Nicholas Pontarolo,
  • Norma Depalma,
  • Marcello Spampinato,
  • Stefano D’Ugo,
  • Luca Lepre,
  • Michela Giulii Capponi,
  • Rossella Domenica Campa,
  • Giuliano Sarro,
  • Vincenza Paola Dinuzzi,
  • Stefano Olmi,
  • Matteo Uccelli,
  • Davide Ferrari,
  • Marco Inama,
  • Gianluigi Moretto,
  • Michele Fontana,
  • Francesco Favi,
  • Erika Picariello,
  • Alessia Rampini,
  • Andrea Barberis,
  • Antonio Azzinnaro,
  • Alba Oliva,
  • Luigi Totaro,
  • Ilaria Benzoni,
  • Valerio Ranieri,
  • Gabriella Teresa Capolupo,
  • Filippo Carannante,
  • Marco Caricato,
  • Maurizio Ronconi,
  • Silvia Casiraghi,
  • Giovanni Casole,
  • Desire Pantalone,
  • Giovanni Alemanno,
  • Maximilian Scheiterle,
  • Marco Ceresoli,
  • Marco Cereda,
  • Chiara Fumagalli,
  • Federico Zanzi,
  • Stefano Bolzon,
  • Enrico Guerra,
  • Francesca Lecchi,
  • Paola Cellerino,
  • Antonella Ardito,
  • Rosa Scaramuzzo,
  • Andrea Balla,
  • Pasquale Lepiane,
  • Nicola Tartaglia,
  • Antonio Ambrosi,
  • Giovanna Pavone,
  • Gian Marco Palini,
  • Simone Veneroni,
  • Gianluca Garulli,
  • Claudio Ricci,
  • Beatrice Torre,
  • Iris Shari Russo,
  • Matteo Rottoli,
  • Marta Tanzanu,
  • Angela Belvedere,
  • Marco Milone,
  • Michele Manigrasso,
  • Giovanni Domenico De Palma,
  • Micaela Piccoli,
  • Gianmaria Casoni Pattacini,
  • Stefano Magnone,
  • Paolo Bertoli,
  • Michele Pisano,
  • Paolo Massucco,
  • Marco Palisi,
  • Andrea-Pierre Luzzi,
  • Francesco Fleres,
  • Guglielmo Clarizia,
  • Alessandro Spolini,
  • Yoshiro Kobe,
  • Takayuki Toma,
  • Fumihiko Shimamura,
  • Robert Parker,
  • Sinkeet Ranketi,
  • Mercy Mitei,
  • Saulius Svagzdys,
  • Henrikas Pauzas,
  • Justas Zilinskas,
  • Tomas Poskus,
  • Marius Kryzauskas,
  • Matas Jakubauskas,
  • Andee Dzulkarnaen Zakaria,
  • Zaidi Zakaria,
  • Michael Pak-Kai Wong,
  • Asri Che Jusoh,
  • Muhammad Nazreen Zakaria,
  • Daniel Rios Cruz,
  • Aurea Barbara Rodriguez Elizalde,
  • Alejandro Bañon Reynaud,
  • Edgard Efren Lozada Hernandez,
  • Jose maria Victor Palomo Monroy,
  • Diego Hinojosa-Ugarte,
  • Martha Quiodettis,
  • María Esther Du Bois,
  • José Latorraca,
  • Piotr Major,
  • Michał Pędziwiatr,
  • Magdalena Pisarska-Adamczyk,
  • Maciej Walędziak,
  • Andrzej Kwiatkowski,
  • Łukasz Czyżykowski,
  • Silvia Dantas da Costa,
  • Bela Pereira,
  • Ana Rita Oliveira Ferreira,
  • Filipe Almeida,
  • Ricardo Rocha,
  • Carla Carneiro,
  • Diego Pita Perez,
  • João Carvas,
  • Catarina Rocha,
  • Cátia Ferreira,
  • Rita Marques,
  • Urânia Fernandes,
  • Pedro Leao,
  • André Goulart,
  • Rita Gonçalves Pereira,
  • Sara Daniela Direito Patrocínio,
  • Nuno Gonçalo Gonçalves de Mendonça,
  • Maria Isabel Cerqueira Manso,
  • Henrique Manuel Cardoso Morais,
  • Paulo Sebastião Cardoso,
  • Valentin Calu,
  • Adrian Miron,
  • Elena Adelina Toma,
  • Mahir Gachabayov,
  • Abakar Abdullaev,
  • Andrey Litvin,
  • Taras Nechay,
  • Alexander Tyagunov,
  • Anvar Yuldashev,
  • Alison Bradley,
  • Michael Wilson,
  • Arpád Panyko,
  • Zuzana Látečková,
  • Vladimír Lacko,
  • Dusan Lesko,
  • Marek Soltes,
  • Jozef Radonak,
  • Victor Turrado-Rodriguez,
  • Roser Termes-Serra,
  • Xavier Morales-Sevillano,
  • Pierfrancesco Lapolla,
  • Andrea Mingoli,
  • Gioia Brachini,
  • Maurizio Degiuli,
  • Silvia Sofia,
  • Rossella Reddavid,
  • Andrea de Manzoni Garberini,
  • Angelica Buffone,
  • Eduardo Perea del Pozo,
  • Daniel Aparicio-Sánchez,
  • Sandra Dos Barbeito,
  • Mercedes Estaire-Gómez,
  • Rebeca Vitón-Herrero,
  • Mª de los Ángeles Gil Olarte-Marquez,
  • José Gil-Martínez,
  • Felipe Alconchel,
  • Tatiana Nicolás-López,
  • Aida Cristina Rahy-Martin,
  • María Pelloni,
  • Raquel Bañolas-Suarez,
  • Fernando Mendoza-Moreno,
  • Francisca García-Moreno Nisa,
  • Manuel Díez-Alonso,
  • María Elisa Valle Rodas,
  • María Carmona Agundez,
  • María Inmaculada Pérez Andrés,
  • Claudia Cristina Lopes Moreira,
  • Aintzane Lizarazu Perez,
  • Iñigo Augusto Ponce,
  • Ana María González-Castillo,
  • Estela Membrilla-Fernández,
  • Silvia Salvans,
  • Mario Serradilla-Martín,
  • Pablo Sancho Pardo,
  • Daniel Rivera-Alonso,
  • Jana Dziakova,
  • Jose Mugüerza Huguet,
  • Naila Pagès Valle,
  • Enrique Colás Ruiz,
  • Cristina Rey Valcárcel,
  • Cristina Ruiz Moreno,
  • Yeniffer Tatiana Moreno Salazar,
  • Juan Jesús Rubio García,
  • Silvia Sevila Micó,
  • Joaquín Ruiz López,
  • Silvia Pérez Farré,
  • Maite Santamaria Gomez,
  • Nuria Mestres Petit,
  • Alberto Titos-García,
  • Jose Manuel Aranda-Narváez,
  • Laura Romacho-López,
  • Luis Sánchez-Guillén,
  • Veronica Aranaz-Ostariz,
  • Marina Bosch-Ramírez,
  • Aleix Martínez-Pérez,
  • Elías Martínez-López,
  • Juan Carlos Sebastián-Tomás,
  • Granada Jimenez-Riera,
  • Javier Jimenez-Vega,
  • Jose Aurelio Navas Cuellar,
  • Andrea Campos-Serra,
  • Anna Muñoz-Campaña,
  • Raquel Gràcia-Roman,
  • Javier Martínez Alegre,
  • Francisca Lima Pinto,
  • Sara Nuñez O’Sullivan,
  • Francisco Blanco Antona,
  • Beatriz Muñoz Jiménez,
  • Jaime López-Sánchez,
  • Zahira Gómez Carmona,
  • Rocio Torres Fernández,
  • Isabel Blesa Sierra,
  • Laura Román García de León,
  • Verónica Polaino Moreno,
  • Eva Iglesias,
  • Paola Lora Cumplido,
  • Altea Arango Bravo,
  • Ignacio Rey Simó,
  • Carlota López Domínguez,
  • Aloia Guerreiro Caamaño,
  • Rafael Calleja Lozano,
  • Manuel Durán Martínez,
  • Álvaro Naranjo Torres,
  • Javier Tomas Morales Bernaldo de Quiros,
  • Gianluca Pellino,
  • Miriam Moratal Cloquell,
  • Elsa García Moller,
  • Sami Jalal-Eldin,
  • Ahmed K. Abdoun,
  • Hytham K. S. Hamid,
  • Varut Lohsiriwat,
  • Aitsariya Mongkhonsupphawan,
  • Oussama Baraket,
  • Karim Ayed,
  • Imed Abbassi,
  • Ali Ben Ali,
  • Houssem Ammar,
  • Ali Kchaou,
  • Ahmed Tlili,
  • Imen Zribi,
  • Elif Colak,
  • Suleyman Polat,
  • Zehra Alan Koylu,
  • Ali Guner,
  • Mehmet Arif Usta,
  • Murat Emre Reis,
  • Baris Mantoglu,
  • Emre Gonullu,
  • Emrah Akin,
  • Fatih Altintoprak,
  • Zulfu Bayhan,
  • Necattin Firat,
  • Arda Isik,
  • Ufuk Memis,
  • Mehmet Bayrak,
  • Yasemin Altıntaş,
  • Yasin Kara,
  • Mehmet Abdussamet Bozkurt,
  • Ali Kocataş,
  • Koray Das,
  • Ahmet Seker,
  • Nazmi Ozer,
  • Semra Demirli Atici,
  • Korhan Tuncer,
  • Tayfun Kaya,
  • Zeynep Ozkan,
  • Onur Ilhan,
  • Ibrahim Agackiran,
  • Mustafa Yener Uzunoglu,
  • Eren Demirbas,
  • Yuksel Altinel,
  • Serhat Meric,
  • Nadir Adnan Hacım,
  • Derya Salim Uymaz,
  • Nail Omarov,
  • Emre Balık,
  • Giovanni D. Tebala,
  • Hany Khalil,
  • Mridul Rana,
  • Mansoor Khan,
  • Charlotte Florence,
  • Christie Swaminathan,
  • Cosimo Alex Leo,
  • Lampros Liasis,
  • Josef Watfah,
  • Ivan Trostchansky,
  • Edward Delgado,
  • Marcelo Pontillo,
  • Rifat Latifi,
  • Raul Coimbra,
  • Sara Edwards,
  • Ana Lopez,
  • George Velmahos,
  • Ander Dorken,
  • Anthony Gebran,
  • Amanda Palmer,
  • Jeffrey Oury,
  • James M. Bardes,
  • Sirivan Suon Seng,
  • Lauren S. Coffua,
  • Asanthi Ratnasekera,
  • Tanya Egodage,
  • Karla Echeverria-Rosario,
  • Isabella Armento,
  • Lena M. Napolitano,
  • Naveen F. Sangji,
  • Mark Hemmila,
  • Jacob A. Quick,
  • Tyler R. Austin,
  • Theodore S. Hyman,
  • William Curtiss,
  • Amanda McClure,
  • Nicholas Cairl,
  • Walter L. Biffl,
  • Hung P. Truong,
  • Kathryn Schaffer,
  • Summer Reames,
  • Filippo Banchini,
  • Patrizio Capelli,
  • Federico Coccolini,
  • Massimo Sartelli,
  • Francesca Bravi,
  • Carlo Vallicelli,
  • Vanni Agnoletti,
  • Gian Luca Baiocchi,
  • Fausto Catena

DOI
https://doi.org/10.1186/s13017-024-00543-w
Journal volume & issue
Vol. 19, no. 1
pp. 1 – 16

Abstract

Read online

Abstract Background Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions After 100 years since the first Hartmann’s procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment’s choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception.

Keywords