Reversal of Hartmann’s Procedure after Perforated Diverticulitis through the Stomal Side without Additional Incisions: The SIR Procedure

Abstract

Aims: Reversal of Hartmann’s procedure (HP) is a complex operation and only performed in 50–60% of the patients. Stomal incision reversal (SIR), a new minimally invasive procedure for HP reversal, was assessed and compared to the standard surgical approach. Methods: 16 patients who had undergone HP for perforated diverticulitis underwent HP reversal by SIR. The only incision in SIR is the one to release the end colostomy. Intra-abdominal adhesiolysis is done manually. A stapled end-to-end colorectal anastomosis is created. The 16 patients who underwent SIR were compared with 32 control patients who were matched according to gender, age, American Society of Anesthesiologists (ASA) classification and Hinchey stage. Results: The operation time was shorter after SIR than after reversal by laparotomy [75 min (58–208) vs. 141 min (85–276); p < 0.001]. Patients after SIR had a shorter hospital stay than patients after laparotomy [4 days (2–22) vs. 9 days (4–64); p < 0.001]. The numbers of total postoperative surgical complications (early and late) were not different (p = 0.13). The anastomotic leakage rate was similar in both groups (6%). The conversion rate in the SIR group was 19% (n = 3). Conclusion: SIR compared favorably with HP reversal by laparotomy in terms of operation time and hospital stay, without increasing the number of postoperative complications.

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

“…The minimal invasive technique of Hartmann reversal using the stoma site as a single incision site has been introduced and described with favorable results compared with laparotomy, such as the stoma incision reversal (SIR) procedure reported by Vermeulen et al [23,24]. However, the SIR procedure does not employ laparoscopic access to the peritoneal cavity.…”

Single-port Laparoscopic Reversal of Hartmann's Procedure: Technique and Results

“…One author describes the reversal through the stomal side with manually adhesiolysis and manually controlled anastomosis [2]. In open surgery, Kunin et al [3] described a morbidity of 47,8% and a mortality of 4,3% after reversal of Hartmann's operation.…”

“…The avoidance of extra incisions, pain and possible complications by multiport access is one big advantage of single-port surgery combined with a better cosmetic result (Table 4). Access through the stomal side and manually preparation without laparoscopic instruments showed a conversion rate of 19% [2] and is therefore not recommended by us.…”

Surgical Access Through the Stoma for Laparoscopic Reversal of Hartmann Procedures

“…Other minimally invasive techniques for RHP have been described, such as the so-called stoma incision reversal (SIR) procedure reported by Vermeulen et al 19 Here the stoma is mobilized as in our technique, and any further adhesiolysis and stapled anastomosis are performed through the same stoma incision. The authors have reported results from a case series of 16 patients, 3 of which were converted to a standard laparotomy approach.…”