Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal

Abstract

PurposeHartmann operation is widely recognized as a useful procedure, especially in emergencies involving the rectosigmoid colon. One of the surgeon’s foremost concerns after Hartmann operation is future colostomy reversal, as colostomy reversal after a Hartmann procedure is associated with relatively high morbidity and mortality. Laparoscopic surgical techniques continue to prove useful for an ever-increasing variety of indications. We analyzed the outcomes of laparoscopic Hartmann colostomy reversals at our center.MethodsWe retrospectively analyzed the hospital records of 170 patients who had undergone Hartmann operation between January 2010 and June 2017 at Wonkwang University Hospital. Among 68 Hartmann colostomy reversals, we evaluated and compared the outcomes of 3 groups of patients: 29 patients in the open colostomy reversal group (OG) who had undergone laparotomies for Hartmann reversals, 19 patients in the conversion group (CG) whose laparoscopic procedures had required conversion to a laparotomy, and 20 patients in the laparoscopy group (LG).ResultsThe overall reversal rate for Hartmann colostomies was 40.5% during this time period. The duration of hospital stay was significantly shorter among LG patients (10.15 ± 2.94 days) than among OG patients (16 ± 9.5 days). The overall complication rate among OG patients was higher than that among LG patients (adjusted odds ratio, 8.78; P = 0.01). The most common complication was postoperative ileus (19.1%).ConclusionIf no contraindications to laparoscopy exist, surgeons should favor a laparoscopic reversal of Hartmann operation over an open reversal.

Laparoscopic Versus Open Hartmann Reversal: A Case-Control Study

“…The significant rate of complications reported following reversal of a Hartmann's colostomy via laparotomy has led many groups to explore the feasibility of laparoscopically assisted reversal. To date, primary procedure (HP) is still preferably performed with an open approach as it is performed after urgent or emergent colonic resections due to suppurative or stercoraceous peritonitis, especially in ASA IV patients [ 9 , 29 , 30 ]. According to the current literature, patients who had undergone several abdominal surgeries and who had clinically relevant cardiovascular and pulmonary comorbidities usually received an OHR [ 31 , 32 ].…”

Laparoscopic Hartmann reversal: experiences from a developing country

“…From previous studies regarding LHR, the LHR principle can be divided into 2 groups of approaches including "stoma first" approach or "stoma the last" approach. In the stoma first approach, authors chose to take down the stoma first; the stoma site was used as a port for trocar or even single port insertion [11][12][13][14]. In our study, we chose to take down the stoma at the end of procedure to make sure everything ready for establishing anastomosis.…”

Effects of Laparoscopic Hartmann Reversal on Short-term Operative Outcomes Among Vietnamese Patients

“…There were only three metaanalysis studies, one of which was based from the results of the American College of Surgeons National Surgical Quality Improvement Program database. [17][18][19] Most retrospective studies included 20 patients [20][21][22][23] ; Park et al investigated 5 patients in particular. 24 Despite the fact that our study included only 66 patients, this was still a major study on laparoscopic reversal of the Hartmann procedure conducted in Asia; furthermore, this is the only study to date that has assessed the safety and advantage of laparoscopic reversal of the Hartmann procedure within the Vietnamese setting.…”

“…No conversions were conducted in the studies by Rosen et al and Fiscon et al 25,26 In contrast, Park et al had a rate of conversion to open surgery of 50% (19 cases). 23 The high conversion rate might be attributed to the presence of associated comorbidity and the difficult technique of this procedure. The main cause of conversion was secondary to dense adhesion and to a short rectal stump.…”