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Ultra-Low Hartmann’s Versus Intersphincteric Abdominal Perineal Resection in Distal Rectal Cancers- A Single Centre Review

Author(s): Gavin Nair, Abdallah Elsabagh, Hong Lee, Charles Livingston, Tiong Sia

Introduction: Patients with distal rectal cancer with predicted poor functional outcome for primary anastomosis, there are two proposed non-restorative surgical management include Ultra Low Hartmann’s (ULH) and Intersphincteric abdominal perineal resection (IAPR). The aim of this study is to compare short term postoperative morbidity and mortality between the two groups.

Methods: Patients who either had a ULH or an IAPR between 2013-2019 in a single centre were included in this retrospective cohort study. Follow-up for 30 days was performed and data was collected and analysed.

Results: A total of 54 patients were included in the study, 14 in the ULH group and 40 in the IAPR group. There was no difference in age between the groups however the ULH had more patients with comorbidities and higher ASA scores compared to the IAPR group. ULH resulted in more severe complications 14% compared to IAPR with 2.5% (p=0.18). three out of 14 patients (21%) in the ULH group develop a pelvic collection compared to one out of 40 (2.5%) in the IAPR group (p=0.01). Reintervention were performed in 2 patients in the ULH group (14%) compared to 5 patients in the IAPR group (12.5%) p=0.24. The readmission rate was 14% in the ULH group and 27.5% in the IAPR group (p=0.73).

Conclusion: The results from the study suggest that IAPR can be considered an alternative to ULH in patients with low rectal cancer given that ULH was associated with a higher rate of pelvic abscesses and reoperation.

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