Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago
Authors: Perrone Gennaro , Giuffrida Mario , Abu-Zidan Fikri , Kruger Vitor F. , Livrini Marco , Petracca Gabriele Luciano , Rossi Giorgio , Tarasconi Antonio , Tian Brian W. C. A. , Bonati Elena , Mentz Ricardo , Mazzini Federico N. , Campana Juan P. , Gasser Elisabeth , Kafka-Ritsch Reinhold , Felsenreich Daniel M. , Dawoud Christopher , Riss Stefan , Gomes Carlos Augusto , Gomes Felipe Couto , Gonzaga Ricardo Alessandro Teixeira , Canton Cassio Alfred Brattig , Pereira Bruno Monteiro , Fraga Gustavo P. , Zem Leticia Gonçalves , Cordeiro-Fonseca Vinicius , de Mesquita Tauil Renato , Atanasov Boyko , Belev Nikolay , Kovachev Nikola , Meléndez L. Juan José , Dimova Ana , Dimov Stefan , Zelić Zdravko , Augustin Goran , Bogdanić Branko , Morić Trpimir , Chouillard Elie , Bajul Melinda , De Simone Belinda , Panis Yves , Esposito Francesco , Notarnicola Margherita , Lauka Lelde , Fabbri Anna , Hentati Hassen , Fnaiech Iskander , Aurélien Venara , Bougard Marie , Roulet Maxime , Demetrashvili Zaza , Pipia Irakli , Merabishvili Giorgi , Bouliaris Konstantinos , Koukoulis Georgios , Doudakmanis Christos , Xenaki Sofia , Chrysos Emmanuel , Kokkinakis Stamatios , Vassiliu Panteleimon , Michalopoulos Nikolaos , Margaris Ioannis , Kechagias Aristotelis , Avgerinos Konstantinos , Katunin Jevgeni , Lostoridis Eftychios , Nagorni Eleni-Aikaterini , Pujante Antonio , Mulita Francesk , Maroulis Ioannis , Vailas Michail , Marinis Athanasios , Siannis Ioannis , Bourbouteli Eirini , Manatakis Dimitrios K. , Tasis Nikolaos , Acheimastos Vasileios , Maria Sotiropoulou , Stylianos Kapiris , Kuzeridis Harilaos , Korkolis Dimitrios , Fradelos Evangelos , Kavalieratos George , Petropoulou Thalia , Polydorou Andreas , Papacostantinou Ioannis , Triantafyllou Tania , Kimpizi Despina , Theodorou Dimitrios , Toutouzas Konstantinos , Chamzin Alexandros , Frountzas Maximos , Schizas Dimitrios , Karavokyros Ioannis , Syllaios Athanasios , Charalabopoulos Alexandros , Boura Maria , Baili Efstratia , Ioannidis Orestis , Loutzidou Lydia , Anestiadou Elissavet , Tsouknidas Ioannis , Petrakis Georgios , Polenta Eleni , Bains Lovenish , Gupta Rahul , Singh Sudhir K. , Khanduri Archana , Bala Miklosh , Kedar Asaf , Pisano Marcello , Podda Mauro , Pisanu Adolfo , Martines Gennaro , Trigiante Giuseppe , Lantone Giuliano , Agrusa Antonino , Di Buono Giuseppe , Buscemi Salvatore , Veroux Massimiliano , Gioco Rossella , Veroux Gastone , Oragano Luigi , Zonta Sandro , Lovisetto Federico , Feo Carlo V. , Pesce Antonio , Fabbri Nicolò , Lantone Giulio , Marino Fabio , Perrone Fabrizio , Vincenti Leonardo , Papagni Vincenzo , Picciariello Arcangelo , Rossi Stefano , Picardi Biagio , Del Monte Simone Rossi , Visconti Diego , Osella Giulia , Petruzzelli Luca , Pignata Giusto , Andreuccetti Jacopo , D’Alessio Rossella , Buonfantino Massimo , Guaitoli Eleonora , Spinelli Stefano , Sampietro Gianluca Matteo , Corbellini Carlo , Lorusso Leonardo , Frontali Alice , Pezzoli Isabella , Bonomi Alessandro , Chierici Andrea , Cotsoglou Christian , Manca Giuseppe , Delvecchio Antonella , Musa Nicola , Casati Massimiliano , Letizia Laface , Abate Emmanuele , Ercolani Giorgio , D’Acapito Fabrizio , Solaini Leonardo , Guercioni Gianluca , Cicconi Simone , Sasia Diego , Borghi Felice , Giraudo Giorgio , Sena Giuseppe , Castaldo Pasquale , Cardamone Eugenia , Portale Giuseppe , Zuin Matteo , Spolverato Ylenia , Esposito Marialusia , Isernia Roberta Maria , Di Salvo Maria , Manunza Romina , Esposito Giuseppe , Agus Marcello , Asti Emanuele Luigi Giuseppe , Bernardi Daniele Tiziano , Tonucci Tommaso Panici , Luppi Davide , Casadei Massimiliano , Bonilauri Stefano , Pezzolla Angela , Panebianco Annunziata , Laforgia Rita , De Luca Maurizio , Zese Monica , Parini Dario , Jovine Elio , De Sario Giuseppina , Lombardi Raffaele , Aprea Giovanni , Palomba Giuseppe , Capuano Marianna , Argenio Giulio , Orio Gianluca , Armellino Mariano Fortunato , Troian Marina , Guerra Martina , Nagliati Carlo , Biloslavo Alan , Germani Paola , Aizza Giada , Monsellato Igor , Chahrour Ali Chaouki , Anania Gabriele , Bombardini Cristina , Bagolini Francesco , Sganga Gabriele , Fransvea Pietro , Bianchi Valentina , Boati Paolo , Ferrara Francesco , Palmieri Francesco , Cianci Pasquale , Gattulli Domenico , Restini Enrico , Cillara Nicola , Cannavera Alessandro , Nita Gabriela Elisa , Sarnari Jlenia , Roscio Francesco , Clerici Federico , Scandroglio Ildo , Berti Stefano , Cadeo Alessandro , Filippelli Alice , Conti Luigi , Grassi Carmine , Cattaneo Gaetano Maria , Pighin Marina , Papis Davide , Gambino Giovanni , Bertino Vanessa , Schifano Domenico , Prando Daniela , Fogato Luisella , Cavallo Fabio , Ansaloni Luca , Picheo Roberto , Pontarolo Nicholas , Depalma Norma , Spampinato Marcello , D’Ugo Stefano , Lepre Luca , Capponi Michela Giulii , Campa Rossella Domenica , Sarro Giuliano , Dinuzzi Vincenza Paola , Olmi Stefano , Uccelli Matteo , Ferrari Davide , Inama Marco , Moretto Gianluigi , Fontana Michele , Favi Francesco , Picariello Erika , Rampini Alessia , Barberis Andrea , Azzinnaro Antonio , Oliva Alba , Totaro Luigi , Benzoni Ilaria , Ranieri Valerio , Capolupo Gabriella Teresa , Carannante Filippo , Caricato Marco , Ronconi Maurizio , Casiraghi Silvia , Casole Giovanni , Pantalone Desire , Alemanno Giovanni , Scheiterle Maximilian , Ceresoli Marco , Cereda Marco , Fumagalli Chiara , Zanzi Federico , Bolzon Stefano , Guerra Enrico , Lecchi Francesca , Cellerino Paola , Ardito Antonella , Scaramuzzo Rosa , Balla Andrea , Lepiane Pasquale , Tartaglia Nicola , Ambrosi Antonio , Pavone Giovanna , Palini Gian Marco , Veneroni Simone , Garulli Gianluca , Ricci Claudio , Torre Beatrice , Russo Iris Shari , Rottoli Matteo , Tanzanu Marta , Belvedere Angela , Milone Marco , Manigrasso Michele , De Palma Giovanni Domenico , Piccoli Micaela , Pattacini Gianmaria Casoni , Magnone Stefano , Bertoli Paolo , Pisano Michele , Massucco Paolo , Palisi Marco , Luzzi Andrea-Pierre , Fleres Francesco , Clarizia Guglielmo , Spolini Alessandro , Kobe Yoshiro , Toma Takayuki , Shimamura Fumihiko , Parker Robert , Ranketi Sinkeet , Mitei Mercy , Svagzdys Saulius , Pauzas Henrikas , Zilinskas Justas , Poskus Tomas , Kryzauskas Marius , Jakubauskas Matas , Zakaria Andee Dzulkarnaen , Zakaria Zaidi , Wong Michael Pak-Kai , Jusoh Asri Che , Zakaria Muhammad Nazreen , Cruz Daniel Rios , Elizalde Aurea Barbara Rodriguez , Reynaud Alejandro Bañon , Hernandez Edgard Efren Lozada , Monroy Jose maria Victor Palomo , Hinojosa-Ugarte Diego , Quiodettis Martha , Du Bois María Esther , Latorraca José , Major Piotr , Pędziwiatr Michał , Pisarska-Adamczyk Magdalena , Walędziak Maciej , Kwiatkowski Andrzej , Czyżykowski Łukasz , da Costa Silvia Dantas , Pereira Bela , Ferreira Ana Rita Oliveira , Almeida Filipe , Rocha Ricardo , Carneiro Carla , Perez Diego Pita , Carvas João , Rocha Catarina , Ferreira Cátia , Marques Rita , Fernandes Urânia , Leao Pedro , Goulart André , Pereira Rita Gonçalves , Patrocínio Sara Daniela Direito , de Mendonça Nuno Gonçalo Gonçalves , Manso Maria Isabel Cerqueira , Morais Henrique Manuel Cardoso , Cardoso Paulo Sebastião , Calu Valentin , Miron Adrian , Toma Elena Adelina , Gachabayov Mahir , Abdullaev Abakar , Litvin Andrey , Nechay Taras , Tyagunov Alexander , Yuldashev Anvar , Bradley Alison , Wilson Michael , Panyko Arpád , Látečková Zuzana , Lacko Vladimír , Lesko Dusan , Soltes Marek , Radonak Jozef , Turrado-Rodriguez Victor , Termes-Serra Roser , Morales-Sevillano Xavier , Lapolla Pierfrancesco , Mingoli Andrea , Brachini Gioia , Degiuli Maurizio , Sofia Silvia , Reddavid Rossella , de Manzoni Garberini Andrea , Buffone Angelica , del Pozo Eduardo Perea , Aparicio-Sánchez Daniel , Dos Barbeito Sandra , Estaire-Gómez Mercedes , Vitón-Herrero Rebeca , de los Ángeles Gil Olarte-Marquez Mª , Gil-Martínez José , Alconchel Felipe , Nicolás-López Tatiana , Rahy-Martin Aida Cristina , Pelloni María , Bañolas-Suarez Raquel , Mendoza-Moreno Fernando , Nisa Francisca García-Moreno , Díez-Alonso Manuel , Rodas María Elisa Valle , Agundez María Carmona , Andrés María Inmaculada Pérez , Moreira Claudia Cristina Lopes , Perez Aintzane Lizarazu , Ponce Iñigo Augusto , González-Castillo Ana María , Membrilla-Fernández Estela , Salvans Silvia , Serradilla-Martín Mario , Pardo Pablo Sancho , Rivera-Alonso Daniel , Dziakova Jana , Huguet Jose Mugüerza , Valle Naila Pagès , Ruiz Enrique Colás , Valcárcel Cristina Rey , Moreno Cristina Ruiz , Salazar Yeniffer Tatiana Moreno , García Juan Jesús Rubio , Micó Silvia Sevila , López Joaquín Ruiz , Farré Silvia Pérez , Gomez Maite Santamaria , Petit Nuria Mestres , Titos-García Alberto , Aranda-Narváez Jose Manuel , Romacho-López Laura , Sánchez-Guillén Luis , Aranaz-Ostariz Veronica , Bosch-Ramírez Marina , Martínez-Pérez Aleix , Martínez-López Elías , Sebastián-Tomás Juan Carlos , Jimenez-Riera Granada , Jimenez-Vega Javier , Cuellar Jose Aurelio Navas , Campos-Serra Andrea , Muñoz-Campaña Anna , Gràcia-Roman Raquel , Alegre Javier Martínez , Pinto Francisca Lima , O’Sullivan Sara Nuñez , Antona Francisco Blanco , Jiménez Beatriz Muñoz , López-Sánchez Jaime , Carmona Zahira Gómez , Fernández Rocio Torres , Sierra Isabel Blesa , de León Laura Román García , Moreno Verónica Polaino , Iglesias Eva , Cumplido Paola Lora , Bravo Altea Arango , Simó Ignacio Rey , Domínguez Carlota López , Caamaño Aloia Guerreiro , Lozano Rafael Calleja , Martínez Manuel Durán , Torres Álvaro Naranjo , de Quiros Javier Tomas Morales Bernaldo , Pellino Gianluca , Cloquell Miriam Moratal , Moller Elsa García , Jalal-Eldin Sami , Abdoun Ahmed K. , Hamid Hytham K. S. , Lohsiriwat Varut , Mongkhonsupphawan Aitsariya , Baraket Oussama , Ayed Karim , Abbassi Imed , Ali Ali Ben , Ammar Houssem , Kchaou Ali , Tlili Ahmed , Zribi Imen , Colak Elif , Polat Suleyman , Koylu Zehra Alan , Guner Ali , Usta Mehmet Arif , Reis Murat Emre , Mantoglu Baris , Gonullu Emre , Akin Emrah , Altintoprak Fatih , Bayhan Zulfu , Firat Necattin , Isik Arda , Memis Ufuk , Bayrak Mehmet , Altıntaş Yasemin , Kara Yasin , Bozkurt Mehmet Abdussamet , Kocataş Ali , Das Koray , Seker Ahmet , Ozer Nazmi , Atici Semra Demirli , Tuncer Korhan , Kaya Tayfun , Ozkan Zeynep , Ilhan Onur , Agackiran Ibrahim , Uzunoglu Mustafa Yener , Demirbas Eren , Altinel Yuksel , Meric Serhat , Hacım Nadir Adnan , Uymaz Derya Salim , Omarov Nail , Balık Emre , Tebala Giovanni D. , Khalil Hany , Rana Mridul , Khan Mansoor , Florence Charlotte , Swaminathan Christie , Leo Cosimo Alex , Liasis Lampros , Watfah Josef , Trostchansky Ivan , Delgado Edward , Pontillo Marcelo , Latifi Rifat , Coimbra Raul , Edwards Sara , Lopez Ana , Velmahos George , Dorken Ander , Gebran Anthony , Palmer Amanda , Oury Jeffrey , Bardes James M. , Seng Sirivan Suon , Coffua Lauren S. , Ratnasekera Asanthi , Egodage Tanya , Echeverria-Rosario Karla , Armento Isabella , Napolitano Lena M. , Sangji Naveen F. , Hemmila Mark , Quick Jacob A. , Austin Tyler R. , Hyman Theodore S. , Curtiss William , McClure Amanda , Cairl Nicholas , Biffl Walter L. , Truong Hung P. , Schaffer Kathryn , Reames Summer , Banchini Filippo , Capelli Patrizio , Coccolini Federico , Sartelli Massimo , Bravi Francesca , Vallicelli Carlo , Agnoletti Vanni , Baiocchi Gian Luca , Catena Fausto 
Published: April 2024

Abstract
Background
Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA.

Methods
This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up.

Results
564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections.

Conclusions
After 100 years since the first Hartmann’s procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment’s choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception.