Hartmann's Reversal and Abdominal Wall Reconstruction: Too Risky to Combine?

BACKGROUND: Patients undergoing Hartmann's reversal (HR) frequently present with an incisional hernia. It is not clear whether HR and incisional hernia repair (IHR) should be performed simultaneously, given the high risk of complications. The aim of this study was to evaluate the outcomes of concomitant HR and IHR. METHODS: Patients who underwent HR between 2012 and 2024 were revised. The sample was divided into two groups: patients who underwent HR alone (HR) and those with concomitant HR and IHR (CP). The primary outcomes were 30-day overall morbidity, major morbidity (Clavien-Dindo III/IV complications), and anastomotic leak rates. Secondary outcomes were surgical site infections (SSI), surgical site occurrences (SSO), length of stay (LOS), reoperation rates, mortality, and hernia recurrence. RESULTS: A total of 52 patients were analyzed: 35 (67%) HR and 17 (33%) CP. Demographic variables were similar between groups. Operative time (HP: 196 vs. CP: 286 min, p = 0.001) was longer in the CP group. Most HR were laparoscopically performed (HR: 33 (94.2%) vs. CP: 2 (11.7%), p < 0.001). 30-day overall morbidity (HR: 15 (42.8%) vs. CP: 12 (70.5%), p = 0.06), major morbidity (HR: 2 (5.7%) vs. CP: 4 (23.5%), p = 0.06), and anastomotic leak (HR: 1 (2.8%) vs. CP: 0 (0%), p = 0.48) rates were similar between groups. No significant differences were observed regarding SSI (HR: 9 (25.7%) vs. CP: 3 (17.6%), p = 0.72) or reoperation rates (HR: 1 (2.8%) vs. CP: 0 (0%), p = 0.48). LOS was similar between groups (HR: 5 (2-16) days vs. CP: 6 (3-13) days, p = 0.2). No recurrences were observed in the CP group after a mean follow-up of 49 (12-132) months. One patient died in the HR group (HR: 1 (2.8%) vs. CP: 0 (0%), p = 0.48). CONCLUSION: Simultaneous HR and IHR might be feasible in very selected patients treated by experienced colorectal and abdominal wall surgeons. The small, heterogeneous, and imbalanced patient cohorts of our study, however, warrant further research to support the safety of the combined approach.