{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:48:04Z","timestamp":1789433284499,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T00:00:00Z","timestamp":1680220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: A Hartmann operation, which is the intervention by which the lower part of the sigmoid and the upper part of the rectum are resected with the closing of the rectal stump and end colostomy, has as its indications: advanced or complicated rectosigmoid neoplasm, moderate biological condition of the patient, peritoneal sepsis, intestinal occlusion and fragile colonic wall, especially in the context of inflammatory changes. The Hartmann procedure can save lives even at the cost of a stoma reversal failure. Methods: The cases operated with the Hartmann procedure by an open approach or laparoscopic approach in our clinic, between 1 January 2016 and 31 December 2020, were admitted in this study and their medical records were reviewed, also making a comparison between the two types of approach. Univariate statistical comparisons but also a multivariate analysis was performed. Results: We performed 985 operations for intestinal and colonic occlusion (7.15% of the total operations in the clinic), 531 (54%) were non-tumor occlusions and 454 (46%) were occlusive tumors (88 Hartmann operations). Of these, 7.3% were laparoscopically performed (7 laparoscopic Hartmann operations and 23 diagnostic laparoscopies). A total of 11 cases (18%) also had colonic perforation. We compared laparoscopic Hartmann with open Hartmann and observed the benefits of laparoscopy for postoperative morbidity and mortality. The presence of pulmonary and cardiac morbidities is associated with the occurrence of general postoperative morbidities, while peritonitis is statistically significantly associated with the occurrence of local complications that are absent after the laparoscopic approach. Conclusions: The Hartmann procedure is still nowadays an operation widely used in emergency situations. Laparoscopy may become standard for the Hartmann procedure and reversal of the Hartmann procedure, but the percentage of laparoscopy remains low due to advanced or complicated colorectal cancer, poor general condition both at the first and second intervention, and the difficulties of reversal of the Hartmann procedure.<\/jats:p>","DOI":"10.3390\/life13040914","type":"journal-article","created":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T03:02:01Z","timestamp":1680231721000},"page":"914","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Laparoscopic Hartmann Procedure\u2014A Surgery That Still Saves Lives"],"prefix":"10.3390","volume":"13","author":[{"given":"Costel","family":"Bradea","sequence":"first","affiliation":[{"name":"First Surgical Clinic, \u201cSt. Spiridon\u201d Hospital Iasi, Independentei Str., No 1, 700111 Iasi, Romania"},{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugen","family":"Tarcoveanu","sequence":"additional","affiliation":[{"name":"First Surgical Clinic, \u201cSt. Spiridon\u201d Hospital Iasi, Independentei Str., No 1, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Munteanu","sequence":"additional","affiliation":[{"name":"First Surgical Clinic, \u201cSt. Spiridon\u201d Hospital Iasi, Independentei Str., No 1, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian Dumitru","family":"Lupascu","sequence":"additional","affiliation":[{"name":"First Surgical Clinic, \u201cSt. Spiridon\u201d Hospital Iasi, Independentei Str., No 1, 700111 Iasi, Romania"},{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florina Delia","family":"Andriesi-Rusu","sequence":"additional","affiliation":[{"name":"First Surgical Clinic, \u201cSt. Spiridon\u201d Hospital Iasi, Independentei Str., No 1, 700111 Iasi, Romania"},{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4761-4133","authenticated-orcid":false,"given":"Delia Gabriela","family":"Ciobanu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9865-5114","authenticated-orcid":false,"given":"Alin Mihai","family":"Vasilescu","sequence":"additional","affiliation":[{"name":"First Surgical Clinic, \u201cSt. Spiridon\u201d Hospital Iasi, Independentei Str., No 1, 700111 Iasi, Romania"},{"name":"Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/S0002-9610(05)80203-X","article-title":"Hartmann\u2019s operation","volume":"168","author":"Rosenman","year":"1994","journal-title":"Am. J. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1111\/j.1463-1318.2005.00862.x","article-title":"Feasibility and morbidity of reversal of Hartmann\u2019s","volume":"7","author":"Banerjee","year":"2005","journal-title":"Colorectal Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1016\/S0140-6736(86)91510-2","article-title":"Recurrence and survival after total mesorectal excision for rectal cancer","volume":"1","author":"Heald","year":"1986","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ijsu.2015.09.047","article-title":"Total Mesorectal Excision, an erroneous anatomical term for the gold standard in rectal cancer treatment","volume":"23","year":"2015","journal-title":"Int. J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Clementi, M., Pietroletti, R., Carletti, F., Sista, F., Grasso, A., Fiasca, F., Cappelli, S., Balla, A., Rizza, V., and Ciarrocchi, A. (2022). Colostomy Reversal following Hartmann\u2019s Procedure: The Importance of Timing in Short- and Long-Term Complications: A Retrospective Multicentric Study. J. Clin. Med., 11.","DOI":"10.3390\/jcm11154388"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s00595-009-4224-1","article-title":"Factors affecting reversal following Hartmann\u2019s procedure: Experience from two district general hospitals in the UK","volume":"41","author":"Tokode","year":"2011","journal-title":"Surg. Today"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1007\/s00384-007-0272-4","article-title":"Analysis of the factors related to the decision of restoring intestinal continuity after Hartmann\u2019s procedure","volume":"22","year":"2007","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/j.1463-1318.2011.02629.x","article-title":"Factors influencing postoperative adverse events after Hartmann\u2019s reversal","volume":"14","author":"Okolica","year":"2012","journal-title":"Colorectal Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e396","DOI":"10.1111\/j.1463-1318.2011.02738.x","article-title":"Hartmann\u2019s operation: How often is it reversed and at what cost? A multicentre study","volume":"13","author":"Roig","year":"2011","journal-title":"Colorectal Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.jamcollsurg.2019.03.007","article-title":"Hartmann\u2019s Procedure vs Primary Anastomosis with Diverting Loop Ileostomy for Acute Diverticulitis: Nationwide Analysis of 2729 Emergency Surgery Patients","volume":"229","author":"Lee","year":"2019","journal-title":"J. Am. Coll. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1002\/bjs.9153","article-title":"Association between operative approach and complications in patients undergoing Hartmann\u2019s reversal","volume":"100","author":"Cellini","year":"2013","journal-title":"Br. J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s10151-008-0393-y","article-title":"Emergency Hartmann\u2019s procedure: Morbidity, mortality and reversal rates among Asians","volume":"12","author":"Leong","year":"2008","journal-title":"Tech. Coloproctol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/j.1445-2197.2005.03367.x","article-title":"Hartmann procedure: Is it still relevant today?","volume":"75","author":"Seah","year":"2005","journal-title":"ANZ J. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.amjsurg.2013.05.006","article-title":"Complications of Hartmann takedown in a decade of preferred primary anastomosis","volume":"207","author":"Garber","year":"2014","journal-title":"Am. J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"s226","DOI":"10.1007\/s10151-004-0164-3","article-title":"Emergency operation in carcinomas of the left colon: Value of Hartmann\u2019s procedure","volume":"8","author":"Meyer","year":"2004","journal-title":"Tech. Coloproctol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1159\/000335726","article-title":"Hartmann\u2019s procedure or primary anastomosis?","volume":"30","author":"Kreis","year":"2012","journal-title":"Dig. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1111\/j.1463-1318.2008.01586.x","article-title":"Use of Hartmann\u2019s procedure in England","volume":"11","author":"David","year":"2009","journal-title":"Colorectal Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1308\/rcsann.2018.0006","article-title":"Hartmann\u2019s procedure, reversal and rate of stoma-free survival","volume":"100","author":"Hallam","year":"2018","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_19","first-page":"46","article-title":"Reversal of Hartmann\u2019s procedure: Experience in an Asian population","volume":"53","author":"Tan","year":"2012","journal-title":"Singap. Med. J."},{"key":"ref_20","first-page":"488","article-title":"Morbidity after reversal of Hartmann operation: Retrospective analysis of 56 patients","volume":"8","author":"Zarnescu","year":"2015","journal-title":"J. Med. Life"},{"key":"ref_21","first-page":"25","article-title":"Trends in the surgical management of diverticulitis","volume":"28","author":"Wieghard","year":"2015","journal-title":"Ann. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1007\/s10350-004-0701-1","article-title":"Primary anastomosis or Hartmann\u2019s procedure for patients with diverticular peritonitis? A systematic review","volume":"47","author":"Salem","year":"2004","journal-title":"Dis. Colon. Rectum."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.jamcollsurg.2007.11.018","article-title":"Emergency laparoscopic management of perforated sigmoid diverticulitis: A promising alternative to more radical procedures","volume":"206","author":"Bretagnol","year":"2008","journal-title":"J. Am. Coll. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/1749-7922-9-52","article-title":"Hartmann\u2019s procedure vs loop colostomy in the treatment of obstructive rectosigmoid cancer","volume":"9","author":"Krstic","year":"2014","journal-title":"World J. Emerg. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1016\/j.amjsurg.2015.10.010","article-title":"Surgeon specialization impacts the management but not outcomes of acute complicated diverticulitis","volume":"211","author":"Wright","year":"2016","journal-title":"Am. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1055\/s-0040-1716703","article-title":"Minimally Invasive Management of Diverticular Disease","volume":"34","author":"Madiedo","year":"2021","journal-title":"Clin. Colon. Rectal Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13017-019-0251-4","article-title":"Primary resection anastomosis versus Hartmann\u2019s procedure in Hinchey III and IV diverticulitis","volume":"14","author":"Halim","year":"2019","journal-title":"World J. Emerg. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1007\/s00384-009-0747-6","article-title":"Reversal of Hartmann\u2019s procedure following acute diverticulitis: Is timing everything?","volume":"24","author":"Fleming","year":"2009","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1002\/bjs.1800790844","article-title":"Timing and method of reversal of Hartmann\u2019s procedure","volume":"79","author":"Pearce","year":"1992","journal-title":"Br. J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1016\/j.surg.2007.08.001","article-title":"Reversal of Hartmann\u2019s procedure: A high-risk operation?","volume":"142","author":"Schmelzer","year":"2007","journal-title":"Surgery"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1089\/lap.2017.0132","article-title":"Case Selection for Laparoscopic Reversal of Hartmann\u2019s Procedure","volume":"28","author":"Celentano","year":"2018","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1007\/s004640000267","article-title":"Laparoscopic vs open colectomy for sigmoid diverticulitis: A prospective comparative study in the elderly","volume":"14","author":"Tuech","year":"2000","journal-title":"Surg. Endosc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1007\/s00464-003-8809-2","article-title":"Laparoscopic vs open resection for the treatment of diverticular disease","volume":"18","author":"Smith","year":"2004","journal-title":"Surg. Endosc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/DCR.0b013e3182749cf5","article-title":"Laparoscopic versus open Hartmann procedure for the emergency treatment of diverticulitis: A propensity-matched analysis","volume":"56","author":"Turley","year":"2013","journal-title":"Dis. Colon. Rectum."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1055\/s-0029-1236162","article-title":"Laparoscopic management of diverticular disease","volume":"22","author":"Lipman","year":"2009","journal-title":"Clin. Colon. Rectal Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1177\/1553350617722226","article-title":"Emergency Hartmann\u2019s Procedure and Its Reversal: A Totally Laparoscopic 2-Step Surgery for the Treatment of Hinchey III and IV Diverticulitis","volume":"24","author":"Cassini","year":"2017","journal-title":"Surg. Innov."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.ejso.2009.08.005","article-title":"Surgical practices for malignant left colonic obstruction in Germany","volume":"36","author":"Kube","year":"2010","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1001\/jamasurg.2013.1","article-title":"Incidence and predictors of bowel obstruction in elderly patients with stage IV colon cancer: A population-based cohort study","volume":"148","author":"Winner","year":"2013","journal-title":"JAMA Surg."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Li, B., Cai, S.-L., Lv, Z.-T., Zhou, P.-H., Yao, L.-Q., Shi, Q., Qi, Z.-P., Di Sun, D., Yalikong, A., and Xu, E.-P. (2020). Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction. BMC Surg., 20.","DOI":"10.1186\/s12893-020-00993-4"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"141","DOI":"10.3393\/ac.2021.01.28","article-title":"Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann\u2019s procedure in acute malignant bowel obstruction in high-risk patients","volume":"38","author":"Mahfouz","year":"2022","journal-title":"Ann. Coloproctol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1111\/codi.15503","article-title":"The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery","volume":"23","author":"Miller","year":"2021","journal-title":"Colorectal Dis."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/4\/914\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:07:49Z","timestamp":1760123269000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/4\/914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,31]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["life13040914"],"URL":"https:\/\/doi.org\/10.3390\/life13040914","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,31]]}}}