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Master Thesis

Chez quels patients proposer un rétablissement de la continuité digestive après intervention de Hartmann ?

Abstract : Introduction: presently, less than half patients is offered a restoration of bowel continuity (RBC) after Hartmann procedure (HP). The point of this study was to evaluate RBC’s predictive factors after HP. Methods: between 2009 and 2016, 360 consecutive patients had an emergency HP in CHU and in 2 CHG. Study criteria included patient background (age, gender, ASA score, comorbidities, body mass index) and the HP’s indication. The primary endpoint was to determinate BCR’s predictive factors; the secondary endpoints targeted an evaluation of a 90 days RBC morbimortality and its risk factors. Results: among the 283 patients alive after 6 months, 189 (67%) had a RBC. The original illness was a diverticular disease in 54% of cases, a cancer in 13%, a vascular cause in 12% and another cause in 21%. In a multivariate analysis, 3 RBC’s independent factors appears: Age below than 70 years (OR 3.78 IC95% [1.88-7.60]), ASA score of less than 3 (OR 2.04 IC95% [1.0.6-3.92]), lack of neurologic comorbidity (OR 4.31IC95% [0.1-0.47]). Among the BCR patients, 3 (1,6%) died at 90 days. 23 patients (12%) developed major’s complications (Dindo-Clavien classification greater than or equal to III), requiring re-do surgery in 19 of them (10%). Conclusion: this study suggests that an age below than 70 years, a ASA score below than 3 and the lack of neurologic comorbidity are predictive factors of RBC after HP. The RBC can be proposed to two thirds of patients without major morbimortality.
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https://dumas.ccsd.cnrs.fr/dumas-02317697
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Submitted on : Wednesday, October 16, 2019 - 11:41:01 AM
Last modification on : Tuesday, April 14, 2020 - 12:23:57 PM

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  • HAL Id : dumas-02317697, version 1

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Daphné Chavrier. Chez quels patients proposer un rétablissement de la continuité digestive après intervention de Hartmann ?. Médecine humaine et pathologie. 2019. ⟨dumas-02317697⟩

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