Adhesiolysis during reconstructive interventions in patients after Hartmann’s procedure (interim results of a randomized trial)

Abstract

The purpose of this work was to evaluate the preliminary results of Hartmann reversal procedures with total and partial adhesiolysis in the abdominal cavity. 64 patients with end colostomies were included in the randomized study from November 2021 to December 2022; 37 patients underwent partial adhesiolysis (main group) during the intervention, and 27 patients underwent complete adhesiolysis (control group). The study groups were comparable in gender, BMI, and status on the ASA scale. During the study, postoperative complications developed in 13 (35 %) cases in the group of partial adhesiolysis and in 6 (22 %) cases in the group of complete adhesiolysis (p = 0.4). In both groups, complications of classes I and II on the Clavien-Dindo scale prevailed. Complications requiring repeated surgical interventions developed in 3 patients of the main group: an anastomotic leak was detected in 2 (5 %) patients, and colon perforation was detected in 1 (3 %) patient, however, the groups were comparable in this parameter (p = 0.6). There was no statistically significant difference in the frequency and structure of postoperative complications or the duration of the postoperative inpatient days between the groups. The volume of adhesiolysis did not affect the duration of surgical interventions, which accounted for 224 minutes in the main group and 200 minutes in the control group. According to the results of regression analysis, the presence of previous peritonitis turned out to be the only predictor that increases the likelihood of postoperative complications (OR = 0.33; 95 % CI: 0.1–1; p = 0.049). Thus, the preliminary results of the randomized study showed no impact of the volume of adhesiolysis on the duration of the intervention and the nature and frequency of postoperative complications.Further research is necessary.