MODIFIED DUHAMEL PROCEDURE AS A METHOD OF RECONSTRUCTIVE COLON SURGERY AFTER HARTMANN PROCEDURE

Objective: to evaluate the efficacy and safety of a new method for restoration of intestinal continuity after Hartmann procedure in patients with rectal cancer.

Materials and methods. We analyzed the results of reconstructive surgeries in patients that underwent obstructive resection of the rectum for rectal cancer between 1991 and 2011. We included patients with a rectal stump located under the pelvic peritoneum (its mean length was 8 (4–11) cm). All study participants underwent modified Duhamel procedure. We evaluated demographic characteristics of patients, as well as early and late postoperative complications.

Results. A total of 9 patients were treated with this method. Median time between the resection and reconstructive surgery was 13.2 months; median surgery duration was 255 min; median blood loss was 800 mL. One patient had an intraoperative complication (spleen injury). Early postoperative complications were observed in 2 (22.2 %) participants; of them, 1 (50 %) patient had necrosis of the brought-out bowel. One patient (11.1 %) developed anastomosis stricture 6 months post surgery.

Conclusion. We developed a new method to restore intestinal continuity after Hartmann procedure. None of the patients had complications associated with rectal stump isolation. The efficiency of this method should be confirmed by larger studies.

rectal cancer, Hartmann procedure, Duhamel procedure

1. Keck J.O., Collopy B.T., Ryan P.J. et al. Reversal of Hartmann’s procedure: effect of timing and technique on ease and safety. Dis Colon Rectum 1994;37(3):243–48. PMID: 8137671.

2. Khan A.L., Ah-See A.K., Crofts T.J. et al. Reversal of Hartmann’s colostomy. J R Coll Surg Edinb 1994;39(4):239–42. PMID: 7807457.

3. Boland E., Hsu A., Brand M.I., Saclarides T.J. Hartmann’s colostomy reversal: outcome of patients undergoing surgery with the intention of eliminating fecal diversion. Am Surg 2007;73(7):664–7. PMID: 17674937.

4. Roig J.V., Cantos M., Balciscueta Z. et al. Hartmann’s operation: how often is it reversed and at what cost? A multicenter study. Colorectal Dis 2011;13(12): e396–402. PMID: 21801298. DOI: 10.1111/j.1463-1318.2011.02738.x.

5. Tan W.S., Lim J.F., Tang C.L., Eu K.W. Reversal of Hartmann’s procedure: experience in an Asian population. Singapore Med J 2012;53(1):46–51. PMID: 22252183.

6. Барсуков Ю.А., Тимофеев Ю.М., Тамразов Р.И. и др. Способ восстановления непрерывности толстой кишки. Патент РФ № 2444313. [Barsukov Yu.A., Timofeev Yu.M., Tamrazov R.I. et al. Method for restoration of intestinal continuity. Patent of the Russian Federation No. 2444313. (In Russ.)].

7. Duhamel B. Technique chirurgicale infantile. Paris: Masson, 1957. Pp. 82–96.

8. Гюльмамедов Ф.И., Миминошвили О.И., Гюльмамедов П.Ф. Особенности выполнения восстановительных операций у больных с одноствольной колостомой. Клиническая хирургия 2003;(6):14–8. [Gyul’mamedov F.I., Miminoshvili O.I., Gyul’mamedov P.F. Reconstructive surgery in patients after single barreled colostomy. Klinicheskaya khirurgiya = Clinical Surgery 2003;(6):14–8. (In Russ.)].

9. Гюльмамедов Ф.И., Полунин Г.Е., Макиенко Е.Г. Выбор метода восстановления кишечной непрерывности после операции Гартмана. Украинский журнал хирургии 2009;(2):53–5. [Gyul’mamedov F.I., Polunin G.E., Makienko E.G. Choosing a method of restoration of intestinal continuity after Hartmann procedure. Ukrainskiy zhurnal khirurgii = Ukrainian Journal of Surgery 2009;(2):53–5. (In Russ.)].

10. Bravo R., Fernandez-Hevia M., JimenezToscano M. et al. Transanal Hartmann reversal: a new technique. Surg Endosc 2016;30(6):2628–31. PMID: 26423412. DOI: 10.1007/s00464-015-4504-3.

11. Krivokapic Z., Barisic G. Problems during Hartmann’s reconstruction. In: Reconstructive surgery of the rectum, anus and perineum. New York: Springer, 2012. Pp. 477–486.