Conventional Versus Minimally Invasive Hartmann Takedown: A Meta‐analysis of the Literature

Abstract

Although end colostomy closure following Hartmann's procedure is a major surgery that is traditionally performed by conventional celiotomy, over the last decade there has been a growing interest toward the application of different minimally invasive techniques. We aimed at evaluating the relative outcomes of conventional surgery versus minimally invasive surgery by meta-analyzing the available data from the medical literature. The PubMed/ MEDLINE, Cochrane Library and EMBASE electronic databases were searched through August 2018. Inclusion criteria considered eligible all comparative studies evaluating open versus minimally invasive procedures. Conventional laparoscopy, robotic and single-port laparoscopy were considered as minimally invasive techniques. Overall morbidity, rate of anastomotic failure, rate of wound complications and mortality were evaluated as primary outcomes. Perioperative details and surgical outcomes were also assessed. The data of a total of 13,740 patients from 26 studies were eventually included in the analysis. There were no significant differences on baseline characteristics such as age, BMI and proportion of high-risk patients between the two groups of patients. As compared to the conventional technique, minimally invasive surgery proved significantly superior in terms of postoperative morbidity, length of hospital stay and rate of incisional hernia. The current literature suggests that minimally invasive surgery should be considered in performing Hartmann's reversal, if technically viable. However, due to the low level of the available evidence it is impossible to draw definitive conclusions.

Outcomes of colostomy takedown following Hartmann's procedure: successful restoration of continuity comes with a high risk of morbidity

“…Conversion rates vary greatly in the literature, which may be related to technique, surgical experience or, more likely, patient selection. A recent meta‐analysis demonstrated conversion rates ranging from 0% to 50%, representing substantial heterogeneity in practice and study populations [9]. The significant reduction in SSI observed in the LHR group aligns with prior published series; however, reduction in EBL, overall morbidity and major morbidity were not observed.…”

“…Successful HR comes with a substantial risk of morbidity, with a 30‐day morbidity rate of over 50%. HR has a high risk of morbidity, with published morbidity rates consistently in the range of 30%–50% [3,4,8,9]. The rate of DLI creation in our series of 21% was higher than in some previously published reports, and may reflect differences in surgical practice or the complexity of surgical cases treated at a tertiary referral centre.…”

Laparoscopic Hartmann reversal: experiences from a developing country

“…Moreover, laparoscopic reversal is beneficial for patients in terms of improved length of stay and 30-day morbidity. Many previous studies showed that the laparoscopic approach to HR should be considered when technically feasible and this approach was associated with fewer complications than open surgery [6,9]. Many different laparoscopic techniques have been described in the literature, but the ideal laparoscopic fashion and the relative advantages of each procedure are still debated.…”

“…The rate of anastomotic leakage ranged from 4% to 16%, the mortality rate was up to 10%, and 46.5% of patients had postreversal complications [2][3][4]. In 1993, Lucchetta and De Manzini [5] and Anderson et al [6] published the first report of a laparoscopic colostomy closure for previous HP. Some recent reviews showed that laparoscopic Hartmann reversal (LHR) brings several advantages over OHR, including fast postoperative recovery, less postoperative pain, earlier restoration of bowel function, and reduced morbidity [4,7].…”

Reversal of Hartmann's Procedure: Evaluating Outcomes of Single-Port Laparoscopic Approach Versus Conventional Approach

“…Since then, colostomy reversal has been a topic of discussion aimed at reducing morbidity and mortality rates [5,6]. While conventional approaches of Hartmann's reversal [HR] such as open surgery (OS) and conventional laparoscopic (CL) surgery have been preferred, laparoscopic approaches have become increasingly favored by many for its reduced postoperative morbidity, wound infection, length of stay, and ileus formation.…”