The Hartmann's procedure involves resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy. In which clinical scenario is reversal of Hartmann's procedure (Hartmann's reversal) associated with the HIGHEST operative mortality and morbidity?
- A Reversal performed 6–12 months after the original procedure in an ASA I–II patient
- B Reversal in an obese patient with multiple comorbidities, performed laparoscopically
- C Reversal in elderly patients with ASA III–IV status, especially those with a long rectal stump and dense pelvic adhesions ✓
- D Reversal performed within 3 months in a fit patient with a short rectal stump
Explanation
Hartmann's reversal carries an overall anastomotic leak rate of 5–10% and mortality up to 5–10% in high-risk populations. The highest risk group comprises elderly patients with significant comorbidities (ASA III–IV), particularly when performed in the context of dense pelvic adhesions from prior pelvic sepsis and a long rectal stump that complicates identification and mobilisation. Early reversal (<3 months) in fit patients is increasingly recommended to improve outcomes. Laparoscopic reversal in obese patients increases difficulty but is not the single highest-risk scenario.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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