Hartmann's procedure (HP) remains controversial because more than half of patients will not recover, thus maintaining a permanent stoma. The aim of this retrospective multicentric study was to evaluate independent predictive factors for Hartmann's reversal (HR) after HP.

Among all consecutive patients who underwent HP between 2009 and 2016 in three hospitals, we included patients who survived for up to 6 months. The primary outcome was to identify independent predictive factors for HR, and the secondary outcomes were to assess both mortality and morbidity rates within 90 days.

Among the 283 patients alive at 6 months, 189 (67%) underwent HR. Indications for HP included complicated diverticulitis in 142 patients (54%), malignancy in 52 patients (13%), colonic ischemia in 16 patients (12%), and miscellaneous in 69 patients (21%). Independent risk factors for HR in multivariate analysis included an age under 70 years (OR 3.78 95% CI [1.88–7.60]), ASA score below 3 (OR 2.04 95% CI [1.0.6–3.92]) and absence of neurological comorbidity (OR 4.31 95% CI [0.1–0.47]). HR was associated with a 1.6% mortality rate within 90 days, and 23 (12%) developed severe postoperative complications (Dindo-Clavien ≥ III), requiring reintervention in 19 of them (82%). At the end of follow-up, 2.6% had a definitive stoma.

This study suggests that HR is possible in 2/3 of patients, especially if they are young, without neurological comorbidities and with a low anesthetic risk. In selected patients, the morbidity and mortality rates are similar to elective colonic resection.