Hartmann’s Reversal: Outcomes, Indications, and Best‑Practice Recommendations

Indications for the Original Hartmann’s Procedure

Perforated diverticulitis with diffuse peritonitis is the most common emergency indication, accounting for roughly 44‑54 % of cases. 1
The procedure is advised for critically ill patients who have multiple comorbidities or hemodynamic instability, because it avoids the high risk of an anastomotic leak in the acute setting. 1

Patients with colorectal cancer must complete neoadjuvant chemoradiotherapy and the full staging work‑up before a reversal is attempted. 3
Optimization of comorbidities, nutritional status, and anemia should be achieved prior to reversal surgery. 3

Laparoscopic reversal should be performed only by surgeons with substantial colorectal expertise and in selected, favorable cases. 3

Poorly controlled diabetes is associated with an increased risk of postoperative complications after reversal. 3
Reversal should not be undertaken in physiologically unstable patients who present with acidosis, hypothermia, or coagulopathy. 3
Inadequate pre‑operative optimization of comorbid conditions and nutritional status is a common pitfall that raises morbidity. 3
Under‑estimating the technical difficulty and potential morbidity of reversal when counseling patients can lead to unrealistic expectations. 1

Hartmann’s reversal carries a substantial overall morbidity of 21‑54 % and successful restoration of bowel continuity is achieved in only about 47 % of patients who initially undergo a Hartmann’s procedure. 1