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Abstract(s)
Introdução A operação de Hartmann, descrita pela primeira vez em 1921 por Henri
Albert Hartmann, consiste na resseção da região retossigmoide, criação de uma
colostomia terminal e oclusão da ampola retal. Atualmente, a indicação mais comum para
este procedimento é a perfuração/obstrução do cólon distal ou reto, geralmente
secundária a diverticulite ou processo neoplásico. A reconstituição posterior do trânsito
intestinal tem sido historicamente associada a uma elevada taxa de complicações,
atribuível tanto às caraterísticas dos utentes quanto à complexidade técnica desta
operação.
Objetivo Este estudo tem como objetivo a descrição das caraterísticas dos doentes
submetidos à Operação de Hartmann e da cirurgia de reconstituição do trânsito intestinal
na população do distrito de Castelo Branco, numa tentativa de definir os critérios de
seleção dos doentes que devem ser submetidos à cirurgia de reversão.
Métodos O presente estudo carateriza-se pela recolha retrospetiva de informação
correspondente ao intervalo de tempo entre 2011 e 2020 dos pacientes submetidos à
Operação de Hartmann no distrito de Castelo Branco.
Resultados O estudo incluiu 139 pacientes. As indicações mais frequentes para a Operação
de Hartmann foram o adenocarcinoma do cólon sigmoide (44,6%), seguido da diverticulite
(18,7%) e do vólvulo do sigmoide (5,0%). A taxa de complicações geral da cirurgia de
Hartmann foi de 56,8% e a taxa de mortalidade pós-operatória (<30 dias) foi de 13,7%. A
taxa de reconstrução intestinal no nosso estudo foi relativamente baixa (29,2%), associada a
uma significativa taxa de complicações (21,2%).
Conclusão A taxa de complicações da cirurgia de reversão nesta série de doentes é
semelhante à reportada na literatura internacional. Assim, a reconstituição do trânsito
intestinal nos utentes do distrito de Castelo Branco, selecionados com base na idade,
patologia e Índice de Charlson, parece ser uma cirurgia segura com taxas de morbilidade
aceitáveis e deve ser considerada como uma opção para os pacientes.
Introduction The Hartmann operation, first described in 1921 by Henri Albert Hartmann, consists of a rectosigmoid resection, closure of the rectal stump and formation of an end colostomy. Currently, the most common indication for this procedure is perforation/obstruction of the distal colon or rectum, usually secondary to diverticulitis or a neoplastic process. The subsequent reconstitution of intestinal transit has historically been associated with a high rate of complications, attributable both to the characteristics of the patients and to the technical complexity of this operation. Objective This study aims to describe the characteristics of patients undergoing Hartmann's operation and bowel transit reconstitution surgery in the population of the Castelo Branco district, in an attempt to define the selection criteria for patients who should undergo reversal surgery. Methods The present study is characterized by the retrospective collection of information corresponding to the time interval between 2011 and 2020 of patients undergoing Hartmann's operation in the district of Castelo Branco. Results The study included 139 patients. The most frequent indications for Hartmann's operation were colon sigmoide cancer (44,6%), followed by diverticulitis (18,7%) and sigmoid volvulus (5,0%). The overall complication rate of the Hartmann surgery was 56,8% and the postoperative mortality rate (<30 days) was 13,7%. The intestinal reconstruction rate in our study was relatively low (29,2 %), associated with a significant complication rate (21,2%). Conclusion The complication rate of the reversal surgery in this series of patients is similar to that reported in the international literature. Thus, the reconstitution of the intestinal transit in patients of the district of Castelo Branco, selected based on age, pathology, and Charlson Index, seems to be a safe surgery with acceptable morbidity rates and should be considered as an option for patients.
Introduction The Hartmann operation, first described in 1921 by Henri Albert Hartmann, consists of a rectosigmoid resection, closure of the rectal stump and formation of an end colostomy. Currently, the most common indication for this procedure is perforation/obstruction of the distal colon or rectum, usually secondary to diverticulitis or a neoplastic process. The subsequent reconstitution of intestinal transit has historically been associated with a high rate of complications, attributable both to the characteristics of the patients and to the technical complexity of this operation. Objective This study aims to describe the characteristics of patients undergoing Hartmann's operation and bowel transit reconstitution surgery in the population of the Castelo Branco district, in an attempt to define the selection criteria for patients who should undergo reversal surgery. Methods The present study is characterized by the retrospective collection of information corresponding to the time interval between 2011 and 2020 of patients undergoing Hartmann's operation in the district of Castelo Branco. Results The study included 139 patients. The most frequent indications for Hartmann's operation were colon sigmoide cancer (44,6%), followed by diverticulitis (18,7%) and sigmoid volvulus (5,0%). The overall complication rate of the Hartmann surgery was 56,8% and the postoperative mortality rate (<30 days) was 13,7%. The intestinal reconstruction rate in our study was relatively low (29,2 %), associated with a significant complication rate (21,2%). Conclusion The complication rate of the reversal surgery in this series of patients is similar to that reported in the international literature. Thus, the reconstitution of the intestinal transit in patients of the district of Castelo Branco, selected based on age, pathology, and Charlson Index, seems to be a safe surgery with acceptable morbidity rates and should be considered as an option for patients.
Description
Keywords
Cólon Diverticulite Hartmann Neoplasia Reconstituição