Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery

Melkonian, E; Heine, Claudio; Contreras, David; Rodriguez, Marcelo; Opazo, Patricio; Silva, Andres; Robles, Ignacio; Rebolledo, R.

doi:10.4103/0972-9941.181329

Cited by 20 publications

(17 citation statements)

References 18 publications

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“…Operation time did not vary significantly among the groups. However, the mean operation times in our study—both among LG patients (224.3 ± 83.5 minutes) and OG patients (222.5 ± 95.5 minutes)—were longer than in other studies (mean time of 149 minutes) [4, 6-8]. In a review of other similar studies, operation time was the interval between the first skin incision and wound closure whereas the time used in our analysis started at the moment of general anesthesia induction and ended at anesthesia recovery because our retrospective data were collected from anesthesia records.…”

Section: Discussioncontrasting

confidence: 77%

“…In our study, the mean LG operation time was longer than the mean OG operation time; even though the difference was not statistically significant, this finding was unexpected. Knowledge of the amount of time required for lysis of adhesions and closure of the laparotomy wound led us to expect that the mean operation time would be longer among OG patients [8].…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal

2018

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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.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal

2018

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“…10 Onkolojik prensipler açısından her iki prosedür de karşılaştırıldığında sağkalım açısından birbirlerine üstünlükleri gösterilememiştir. 5 Yılmaz ve ark. Laparoskopik Kolorektal Cerrahi Deneyimimiz ve daha az immün fonksiyonda bozulma olduğunu göstermişlerdir.…”

Section: Discussionunclassified

“…4 Açık cerrahiye bakıldığında ise, maliyet olarak laparoskopik cerrahi daha yüksek maliyete sahip iken, hastanede kalış süresi, postoperatif daha az ağrı olması ve derlenme süresinin daha kısa olması, bunun sonucunda da onkolojik hastalarda yara yeri iyileşmesinin iyi olması ve adjuvan tedaviye daha çabuk başlanması gibi önemli avantajlara sahip olduğu bildirilmektedir. 1,5 Günümüzde kolorektal cerrahide halen laparoskopik yöntem altın standart olarak kabul edilmemiştir. Ayrıca spesmeni çıkartmak için yapılan kesi nedeniyle bazı cerrahlar tarafından "el yardımlı" cerrahi olarak yorumlansa da birçok araştırmada açık cerrahiye alternatif olarak gösterilmiştir.…”

Section: Introductionunclassified

Our Experience of Laparoscopic Colorectal Surgery: Short Term Outcomes

Yılmazq¹,

Cartı²,

Kandemır³

2016

TJCD

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Amaç: Laparoskopik kolorektal cerrahi günümüzde birçok merkezde yaygın olarak kullanılan bir prosedür halini almaya başlamıştır. Kliniğimizdeki ilk laparoskopik kolorektal cerrahi olgularımızın erken dönem sonuçlarını sunmayı planladık. Yöntem: Eylül 2014-Ağustos 2016 tarihleri arasında Adnan Menderes Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı Kliniği'nde laparoskopik kolorektal cerrahi uygulanan olgular çalışmaya dahil edilmiştir. Bulgular: Çalışmamıza toplam 30 hasta dahil edildi. On bir olguya (%36,7) Low anterior rezeksiyon, 10 olguya (%33,3) sağ kolektomi, yedi olguya (%23,3) anterior rezeksiyon, bir olguya (%3,3) total kolektomi, bir olguya da (%3,3) abdominoperineal rezeksiyon işlemi uygulandı. Ortalama ameliyat süresi 149,67 dakika (aralık, 100-300) olarak kaydedildi. Hastaların ortalama hastanede yatış süreleri 6,87 gün (aralık, 3-34) olarak belirlendi. Toplam iki hastada (%6,7) anastomoz kaçağı gelişirken, bir hastada (%3,3) üreter hasarı, beş hastada (%16,7) yara yeri enfeksiyonu gelişti. Sonuç: Laparoskopik kolorektal cerrahi sonuçlarımız literatür ile benzer sonuçlar vermektedir. Anahtar Kelimeler: Laparoskopi, kolorektal cerrahi, deneyim ABSTRACT ÖZAim: Currently laparoscopic colorectal surgery began to be a widely used procedure in many centers. We aimed to present early period outcomes of first group of patients who had laparoscopic colorectal surgery in our clinic. Method: Included were 30 patients who underwent laparoscopic colorectal surgery between September 2014 and August 2016 in Adnan Menderes University Faculty of Medicine General Surgery Clinic. Results: A total of 30 patients were included to this study. Low anterior resection were performed in 11 (36.7%) patients, right colectomy in 10 (33.3%) patients, anterior resection in seven (23.3%) patients, total colectomy in one (3.3%) patient, abdominal perineal resection in one (3.3%) patient. Median operation time was 149.67 (range, 100-300) minutes. The median postoperative length of stay was 6.87 (range, 3-34) days. Anastomic leakage occurred in two patients (6.7%), ureter damage in one patient (3.3%), and wound infection in five patients (16.7%). Conclusion: Our laparoscopic colorectal surgery outcomes and the literature shows similarity.

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“…Conventional multiport laparoscopic (CL) RoH appears to have less morbidity than open surgery (OS) RoH [10][11][12][13], although there is a paucity of randomized data. The technique of single-incision laparoscopic (SIL) RoH through the stoma site was first reported in 2011 [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Single‐incision laparoscopic reversal of Hartmann's operation through the stoma site: comparative outcomes with conventional laparoscopic and open surgery

et al. 2019

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Aim Restoration of bowel continuity after Hartmann's procedure (RoH) can be challenging and associated with considerable morbidity. A technique using single-incision laparoscopic surgery through the stoma site (SIL RoH) has been shown to be feasible and safe. In this study, we compared clinical outcomes of SIL RoH with conventional laparoscopic surgery (CL) and open surgery (OS).Methods This was a retrospective analysis of a prospectively maintained database between 2007 and 2017 in a UK colorectal unit. The access technique was decided by the surgeon on a case by case basis.Results A total of 106 patients underwent RoH. It was carried out for diverticular disease (n = 71, 67.6%), cancer (n = 19, 17.9%) and anastomotic leak (n = 4, 3.8%). The remainder (n = 12, 11.3%) were for miscellaneous reasons including trauma. Most RoHs were performed via OS (n = 87, 81.1%). The most common intended approaches for RoH were SIL (n = 56, 52.8%) and OS (n = 34, 32.1%) with fewer starting with CL (n = 16, 15.1%). Conversion to OS took place in five (8.9%) patients with SIL and six (37.5%) with CL (P = 0.005). Postoperative complications occurred in 17 (30.4%) for SIL, seven (43.8%) for CL and 17 (50.0%) for OS (P = 0.162). Median operating time for SIL was 146 min (range 44-389), 211 min (109-320) for CL and 211 min (85-420) for OS (P < 0.001). Median length of stay was 4 days (2-44) for SIL compared to 6 (3-34) for CL and 7 (4-34) for OS (P < 0.001). Discharge on or before day 5 was achieved in 41 (74.5%) patients for SIL compared to six (37.5%) for CL and seven (20.6%) for OS (P < 0.001).Conclusion Compared to OS and CL, SIL RoH appears to have shorter operating times and hospitalization, with no discernible difference in morbidity; this finding requires further evaluation in a randomized setting.Keywords Single-incision laparoscopic surgery, laparoscopic surgery, single-port laparoscopic surgery, reversal of Hartmann's procedure What does this paper add to the literature? There is little evidence for the efficacy and benefits of single-incision laparoscopic surgery for the reversal of Hartmann's procedure, but this study suggests potential better short-term clinical outcomes over conventional laparoscopic and open surgery. We believe that a prospective randomized control trial would add further support for adoption of this technique.

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Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery

Cited by 20 publications

References 18 publications

Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal

Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal

Our Experience of Laparoscopic Colorectal Surgery: Short Term Outcomes

Single‐incision laparoscopic reversal of Hartmann's operation through the stoma site: comparative outcomes with conventional laparoscopic and open surgery

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