Laparoscopic colostomy reversal after a Hartmann procedure: a prospective series, literature review and an argument against laparotomy as the primary approach

Abstract

Laparoscopic colostomy reversal after a Hartmann procedure: a prospective series, literature review and an argument against laparotomy as the primary approach Background: Open restoration of bowel continuity after a Hartmann procedure has been associated with significant morbidity, including anastomotic leak, incisional hernia, wound infections and inability to re-establish intestinal continuity. Few studies have examined the role of laparoscopy in performing a Hartmann reversal. The aim of this study was to review our laparoscopic Hartmann reversal (LHR) experience with an emphasis on intra-and postoperative adverse events. Methods:A prospectively collected laparoscopic colorectal database involving 3 surgeons in 4 academic centres between 1991 and 2008 was reviewed. Factors evaluated were patient demographics, diagnosis, duration of surgery, intra-and postoperative complications, recovery of bowel function and length of stay in hospital.Results: Twenty-eight consecutive patients (13 men, 15 women) with a mean age of 61.1 (standard deviation [SD] 15.3) years and a mean weight of 72.3 (SD 20

Hartmann’s procedure and laparoscopic reversal versus primary anastomosis and ileostomy closure for left colonic perforation

“…Our present findings showed a colostomy reversal rate of as high as 75 % despite high comorbidity and ASA scores. We found no disadvantage in terms of the time interval between resection to reversal in strategy A compared to strategy B, which again was in disagreement with current literature [5,26]. The present high colostomy reversal rate could be explained by the fact that laparoscopic reversal was already planned at time of primary intervention, and patients were followed closely until reversal.…”

“…The laparoscopic Hartmann's reversal (LHR) appears to be a promising alternative to open surgery with data showing benefits regarding morbidity, postoperative recovery, reoperation rates, and length of hospital stay [5,[23][24][25][26]. A comparison of LHR and open Hartmann reversal in 4148 patients out of the American College of Surgeons National Surgical Quality Improvement Program database showed a significant lower overall complication rate in favor of the laparoscopic approach (18.4 versus 27 %, p<0.0001) [27].…”

Single-port laparoscopic reversal of Hartmann's procedure via the colostomy site

“…As minimally invasive techniques become more popular in colorectal surgery, a laparoscopic approach has been attempted to reduce the morbidity and mortality of the reversal of Hartmann's procedure [5,10]. Studies have shown improved outcomes, such as fewer postoperative complications, a lower mortality rate, and a shorter hospital stay with a laparoscopic approach [6,11].…”

Surgical Access Through the Stoma for Laparoscopic Reversal of Hartmann Procedures

“…A recent study that reviewed nationwide trends in the use of Hartmann procedure and RHP in the United Kingdom showed that only 23% of patients had their stoma reversed in a 4-year period after their primary operation. 10,12,13 Here, we describe our own technique for lapRHP, where the optic is inserted through the stoma and a limited left-sided dissection is performed to mobilize the rectal stump. 2,7,8 If complication rates after RHP could potentially be reduced, then it is likely that the number of reversal procedures will increase and the percentage of patients left with a permanent stoma will decline as a result.…”