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. 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. 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. 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.

中文翻译：

---

再见哈特曼试验：一项针对一个世纪前开发的外科手术当前使用情况的前瞻性、国际、多中心、观察性研究


文献建议用结肠切除加一期吻合术（RPA）代替哈特曼手术（HP）来治疗左侧结肠急症。我们的目的是比较 HP 和 RPA，评估全球用于治疗急性左侧结肠急症患者的手术选择以及导致选择治疗的因素。这是一项在 ClinicalTrials.gov 上注册的前瞻性、国际、多中心观察性研究。 2020年3月1日至2020年5月31日期间，共纳入来自204个中心的1215名需要手术的左侧结肠急症患者，并进行了为期1年的随访。 564 名患者（43.1%）为女性。平均年龄为 65.9 ± 15.6 岁。 697 例 (57.3%) 患者进行了 HP，384 例 (31.6%) 患者进行了 RPA。复杂性急性憩室炎是左侧结肠急症的最常见原因（40.2%），其次是结直肠恶性肿瘤（36.6%）。 HP 组的严重并发症 (Clavien-Dindo ≥ 3b) 较高 (P < 0.001)。 HP 患者的 30 天死亡率较高（13.7%），特别是在肠穿孔和弥漫性腹膜炎的情况下。 1 年随访显示 HP 和 RPA 的造口复通率没有差异。 （P = 0.127）。后向似然 Logistic 回归模型显示，对于年轻患者、ASA 评分较低（≤ 3）、大肠梗阻、无结肠缺血、从入院到手术时间较长、在白天工作时间较早进行手术的患者，RPA 是首选，由一位进行了 50 多次结直肠切除术的外科医生完成。自第一次哈特曼手术以来 100 年后，HP 仍然是左侧结直肠急症最常见的治疗方法。 治疗方法的选择取决于患者特征、手术时间和外科医生的经验。 RPA 应被视为手术的黄金标准，HP 是一个例外。