Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients

Abstract

Background Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. “Temporary” colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30‐day mortality, length of stay, complications, and postoperative outcomes. Results Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II‐III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission ( p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.

One‐step totally robotic Hartmann reversal and complex abdominal wall reconstruction with bilateral posterior component separation: a technical note

“…Hartmann reversal associated with a complex abdominal wall anatomic reconstruction is feasible with an MIS approach using robotic assistance, thus reducing surgical trauma. The MIS approach has also reduced postoperative ileus after such procedures [7].…”

“…Hartmann reversal associated with a complex abdominal wall anatomic reconstruction is feasible with an MIS approach using robotic assistance, thus reducing surgical trauma. The MIS approach has also reduced postoperative ileus after such procedures [7]. Precise haemostasis [12] and limited impact on respiratory function due to the absence of a laparotomy [13] might also improve the postoperative course.…”

“…The evidence in the literature favours the minimally invasive (MIS) approach for Hartmann's reversal regarding surgical site and general complications [6, 7]. Similarly, the MIS approach to complex AWR with posterior component separation is gaining traction, with a potential role in reducing surgical site complications and hospital stay compared with traditional open approaches [8].…”

“…Concerns have been raised about the one-step approach to Hartmann reversal with abdominal wall reconstruction (AWR) [1,2]. Despite this, several datasets and trials suggest that synthetic mesh hernia repairs in contaminated fields are safe [3][4][5].The evidence in the literature favours the minimally invasive (MIS) approach for Hartmann's reversal regarding surgical site and general complications [6,7]. Similarly, the MIS approach to complex AWR with posterior component separation is gaining traction, with…”

Application of single-incision laparoscopic-assisted technique for the closure of end colostomy with intestinal shortening

“…However, reduction of colostomy is challenging given the presence of abdominal adhesions and shortened colon. The laparoscopic technique has special advantages such as minor trauma, magni ed eld of view, and wide range of operation, thus it is increasingly used in colorectal surgery and has advantages in the dissection of abdominal adhesions [2,3].These advantages are even more signi cant in single-incision laparoscopic surgery. In present study, we reported our preliminary experiences of closing end colostomy via single-incision laparoscopicassisted technique.…”