The Open Anesthesia Journal

Formerly: The Open Anesthesiology Journal

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Hartmann’s Procedure for Complicated Diverticulitis: A Critical Reappraisal

Raffaele Costantini1, *
1 Institute of Surgical Pathology, Department of Medical, Oral and Biotechnological Sciences, “G D’Annunzio” University of Chieti, Chieti and Pescara, Italy



Complicated diverticulitis in advanced stages (Hinchey III, IV) is an important surgical emergency for which Hartmann’s Procedure (HP) has traditionally represented the gold standard treatment. HP, however, has high mortality and morbidity and a low percentage of reanastomosis rate. Increasing efforts have therefore been made in recent years to propose alternatives.


To critically review studies on the outcome of HP vs. alternative procedures for complicated diverticulitis Resection-Anastomosis without [RA] or with [RAS] protective stomia, Laparoscopic Lavage [LL].


Literature search in PubMed for original and review papers in the past 20 years (up to July 2019) with keywords: Hartmann’s procedure, complicated diverticulitis.


Comparative studies on HP vs. RA/RAS overall reveal better outcomes of RA/RAS, i.e., reduced mortality, morbidity and healthcare costs. However, most studies have limitations due to lack of randomization, limited number of patients and significant impact of surgeons’ specialization and hospital setting/organization in the decision of the type of surgery to perform. These factors might induce preferential allocation of the most critical patients (advanced age, hemodynamic instability, numerous comorbidities) to HP rather than RA/RAS. LL shows promising results but has been tested in a too small number of trials vs. HP to draw definite conclusions.


Though valid alternatives to HP are being increasingly employed, consensus on the best approach to complicated diverticulitis has not yet been reached. HP is still far from representing an obsolete intervention, rather it appears to be the preferred choice in the most critical patients.

Keywords: Complicated diverticulitis, Hinchey III, Hinchey IV, Hartmann’s procedure, Resection-anastomosis, Laparoscopic lavage.

Article Information

Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 121
Last Page: 131
Publisher Id: TOATJ-13-121
DOI: 10.2174/2589645801913010121

Article History:

Received Date: 14/08/2019
Revision Received Date: 16/09/2019
Acceptance Date: 13/10/2019
Electronic publication date: 15/11/2019
Collection year: 2019

© 2019 Raffaele Costantini.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: Address correspondence to this author at the Institute of Surgical Pathology, G D’Annunzio University of Chieti, Chieti and Pescara, Italy; Tel/Fax: 0039-0871-541207;

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