Laparoscopic Versus Open Hartmann Reversal: A Case-Control Study

Abstract

Background. Laparoscopic reversal of Hartmann’s procedure (LHR) offers reduced morbidity compared with open Hartmann’s reversal (OHR). The aim of this study is to compare the outcome of laparoscopic versus open Hartmann reversal. Materials and Methods. Thirty-four patients who underwent Hartmann reversal between January 2017 and July 2019 were evaluated. Patients underwent either LHR (n = 17) or OHR (n = 17). Variables such as numbers of patients, patient’s age, sex, body mass index (BMI), comorbidities, ASA (American Society of Anesthesiology) score, indication for previous open sigmoid resection, mean operation time, rate of conversion to open surgery, length of hospital stay, mortality, and morbidity were retrospectively evaluated. Results. The two groups of patients were homogeneous for gender, age, body mass index, cause of primary surgery, time to reversal, and comorbidities. In 97% of the cases, HP was done by open surgery. Our data revealed no difference in mean operation time (LHR: 180.5 ± 35.1 vs. OHR: 225.2 ± 48.4) and morbidity rate, although, in OHR group, there were more severe complications. Less intraoperative blood loss (LHR: 100 ± 40 mL vs. OHR: 450 ± 125 mL; p value <0.001), shorter time to flatus (LHR: 2.4 days vs. OHR: 3.6 days; p value <0.021), and shorter hospitalization (LHR: 4.4 vs. OHR: 11.2 days; p value <0.001) were observed in the LHR group. Mortality rate was null in both groups. Discussion. LHR is feasible and safe even for patients who received a primary open Hartmann’s procedure. We suggest careful patient’s selection allowing LHR procedures to highly skilled laparoscopy surgeons.

Comparison of outcomes between laparoscopic and open Hartmann's reversal: A single‐center retrospective study in Japan

“…There have been fewer reports on HR from East Asia than from Western countries 1,6,7,11,12,16,17 . Additionally, the rate of HR in our study was lower (14.3%) than reported in previous studies from Western countries (21%–63%) 1,6,16 and East Asia (19%–44%) 7,18 .…”

“…HP is often performed as an emergency operation, and in such cases, surgeons tend to prefer open HP (OHP) over laparoscopic HP (LHP) 12 . In HR, the previous surgical approach is an important factor to consider due to its effect on intra‐abdominal adhesions; however, there is no literature on the effect of the surgical approach in HP on the operative outcomes of LHR.…”

Laparoscopic reversal of Hartmann’s procedure: a hospital-based prospective observational study

“…Mean operative time was 184.6±47.06min in our study and it corresponds well with the study conducted by Panaccio et al in the period between January 2017 and July 2019 in the department of medicine and oral sciences and biotechnologies, unit of general and oncology surgery, Casa Di Cura Pierangeli, University G. D'Annunzio, Chieti-Pescara, Italy in which mean operative time was 180.5±35.1 minutes in the LHR group. 16 In a review of other similar studies, operation time was the interval between the first skin incision and wound closure. Patients having short rectal stump, rectosigmoid colon cancer, and previous radiotherapy in the pelvis resulting in dense adhesions and fibrotic stricture of the rectal stump increase the operative time.…”

Factors Predicting the Reversal of Hartmann’s Procedure

“…Previous studies have reported that 6–35% of patients who undergo HP do not proceed to reversal, leading to a permanent stoma [ 4 , 14 – 17 ]. Horesh et al reported Hartmann's reversal rate of 57.6% when those who died within the perioperative 30 days after HP were excluded [ 18 ].…”