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

Abstract

In general, reversal of Hartmann's procedure is associated with a high morbidity and therefore leads to a low rate of intestinal restoration. Reversal of Hartmann's procedure has to be seen as a complex abdominal operation with the same possible complications as in other colorectal resections. By using the laparoscopic technique, operative access trauma by laparotomy can be minimized. After introducing single-port access into laparoscopic surgery beginning with cholecystectomies and sigmoid resections, we started with the first single-port laparoscopic reversal of Hartmann's procedure in January 2010. After excision of the colostoma, mobilization, and reponing into the abdominal cavity, the single-port trocar was placed at the stoma incision without any extra scar. We investigated whether the single-port laparoscopic reversal is as safely feasible as the “conventional” laparoscopic procedure. Till December 2010, single-port reversal operation was performed in 8 patients 2–4 months after Hartmann's procedure because of complicated diverticulitis. No conversion to “conventional” laparoscopic or open procedure was necessary in 1 patient one extra 5 mm trocar was used. The average operation time was 74 min. Except for one wound complication, the postoperative course was uncomplicated. The patients were discharged after 4 to 8 postoperative days. Single-port reversal of Hartmann's procedure has showed as a new method for minimizing the access trauma even further than “conventional” laparoscopic surgery.

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

“…In our series of 28 patients, intra-and postoperative adverse events (3.6% and 10.7%, respectively) compared favourably with that reported in the open surgery (13%-50%) [1][2][3][4][5] and laparoscopic surgery (9%-25%) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] literature for reversal of a Hartmann procedure. No clinical leaks were encountered, and there was no mortality.…”

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The largest study was that of Vacher and colleagues 13 and consisted of 38 patients. Their conversion rate was 15.8% (6 of 38), the morbidity rate was 23.5% and the mortality rate was 2.7%.…”

Laparoscopic Hartmann’s procedure: a viable option for treatment of acutely perforated diverticultis

“…Our results compare favorably with those of other series, which report a conversion rate of 9% to 25%, a mean operative time of 158 min (range, 69-240 min), an average hospital stay of 4.2 days (range, 4-18 dyas), a surgical-site infection rate of 14%, an anastomotic leak rate of 15%, a reoperation rate of 7.1%, and a mortality rate of 2.6% to 10% [14][15][16][17][18][19][20][21][22][23][24].…”

Emergency Laparoscopic Sigmoidectomy for Perforated Diverticulitis with Generalised Peritonitis: A Systematic Review

“…In addition, all reversals were performed laparoscopically. The reversal rate in the present review is comparable to a reported 82% for laparoscopic reversal in a study by Carus et al [50] . Because laparoscopic reversal is less invasive and associated with lower morbidity, it is likely that more patients will be evaluated as fit for surgery.…”