Comparison between primary anastomosis without diverting stoma and Hartmann’s procedure for colorectal perforation; a retrospective observational study

Abstract

Abstract Background Hartmann’s procedure (HP) has been performed for colorectal perforation to avoid the risk of anastomotic leakage. Few reports have compared the safety between primary anastomosis without diverting stoma (PAWODS) and HP for colorectal perforation, and whether PAWODS or HP should be performed has remained controversial. We aimed to investigate the feasibility and safety of performing PAWODS in comparison to HP for colorectal perforation. Methods We retrospectively collected the data of 97 consecutive patients with colorectal perforation who underwent surgery from April 2010 to December 2020. PAWODS and HP were performed in 51 and 46 patients, respectively. Univariate and multivariate analyses were performed to compare the clinical characteristics and postoperative outcomes of patients treated with PAWODS with those treated with HP . Results In the multivariate analysis, low serum albumin (hazard ratio [HR] = 3.49 [95%CI = 1.247–9.757] P = 0.017) and left-sided colon and rectum perforation (HR = 16.8 [95%CI = 1.792-157.599] P = 0.014) were significantly associated with the decision to perform HP. There was significant difference in the mortality of the two groups (PAWODS vs. HP: 0% vs. 8.7%; P = 0.047). The severe morbidity rate (Clavien-Dindo III-V) was significantly higher in the HP group (PAWODS vs. HP: 10% vs. 30%; P = 0.020). In the PAWODS group, anastomotic leakage occurred in 5 of 51 patients (9.8%), 4 (8.7%) of whom required re-operation. Conclusions In appropriately selected patients, PAWODS could be safely performed with an acceptable rate of anastomotic leakage. The serum albumin level and site of perforation may be simple and useful factors for guiding decision-making on the surgical procedure.