Abdominoperineal resection or low Hartmann's procedure

Aim: To compare patients having low Hartmann's resection (LHP) with abdominoperineal resection (APR) by investigating postoperative complications. Methods: Retrospective comparative analysis of preoperative state and postoperative course for patients having surgery from 1 January 1997 to 1 July 2001, by the surgeons of the Colorectal Unit, Christchurch Hospital, Christchurch, New Zealand. Results: Over a 54-month period 65 patients underwent either LHP or APR (29 LHP, 36 APR). The median age/sex (male:female) of patients for LHP was 76 years (51-90 years) (14:15), for APR 72 years (31-93 years) (19:17). The indication for surgery was predominantly cancer (LHP 89.6%, APR 94.4%). There was a high rate of preoperative comorbidities: LHP 75.9% (cardiac 62.1%, pulmonary 17.2%), APR 75% (cardiac 50%, pulmonary 15.9%). Preoperative chemoradiation was used in 10.3% of patients having LHP and 30.6% with APR. There was no difference in postoperative non-septic complications. There was a significant difference in the types of septic complications (P = 0.018), with a higher rate of pelvic abscesses after LHP (5). Perineal wound infection occurred in five patients having APR (14.3%). The median time to heal a perineal wound was 1 month (0.5-7 months). The median length of stay was 13 days for LHP (5-33 days) and 11 days for APR (6-19 days)(P = 0.0266). Conclusion: This non-randomized, retrospective, cohort study shows a surprisingly high rate of pelvic abscesses after LHP compared with APR. Perineal wound healing was a problem after APR, but less of a management problem than the septic complications after LHP. Both LHP and APR might be associated with significant morbidity. A high pelvic abscess rate following LHP is associated with a high likelihood of further surgical intervention and a prolonged length of stay.