Laparoscopic Reversal of Hartmann’s Procedure: State of the Art 20 Years after the First Reported Case

Abstract

Introduction. Aim of the present work is to review the literature to point out the role of laparoscopic reversal of Hartmann procedure. Material and Methods. Number of patients, age, sex, etiology, Hinchey classification, interval between procedure and reversal, position of the first trocars, mean operative time (min), number and causes of conversion, length of stay, mortality, complications, and quality of life were considered. Results. 238 males (52.4%) and 216 females (47.6%) between 38 and 67 years were analyzed. The etiology was diverticulitis in 292 patients (72.1%), carcinoma in 43 patients (10.6%), and other in 70 patients (17.3%). Only 7 articles (22.6%) reported Hinchey classification. The interval between initial procedure and reversal was between 50 and 330 days. The initial trocar was open positioned in 182 patients (43.2%) through umbilical incision, in 177 patients (41.9%) in right upper quadrant, and in 63 patients (14.9%) in colostomy site. The operative time was between 69 and 285 minutes. A total of 83 patients (12.1%) were converted and the causes were reported in 67.4%. The length of stay was between 3 and 12 days. 5 patients (0.7%) died. The complications concern 112 cases (16.4%). Conclusion. The laparoscopic Hartmann's reversal is safer and achieves faster positive results.

Laparoscopic Reversal of Hartmann Procedure: A Single Surgeon Experience

“…Some other authors used the palmer point as entry technique and it was also considered as a safe way of entry [11]. The adhesions are the main cause of conversion to the open technique during laparoscopic reversal procedure [4,6]. In our case series; the only case of conversion was due to severe adhesions.…”

“…Only one procedure was converted to laparotomy due to severe pelvic adhesions (Table 2). When surgical procedure is indicated, the immediate intestinal continuity is used more and more [4]. The only indication, as a gold standard for HP, remains the stercoral peritonitis due to a sigmoid perforation [5].…”

“…Thus, many surgical teams thought of different ways to reduce this morbidity. One of them was the use of laparoscopy and its known advantages on open procedure to re-establish the intestinal continuity have been well demonstrated in the last twenty years [4]. Rapid postoperative recovery, less postoperative pain, earlier Ambulation, earlier restoration of bowel function, a more rapid return to a normal diet, and Reduced morbidity are the major advantages of this technique [6].…”

“…This method allows the exploration of the abdominal cavity, assessment of the feasibility of laparoscopy and adhesiolysis; with dissection of the colostomy under direct vision [4]. In our case series, we started with dissection of the Colostomy and used the incision as the way of the entry a purse-string suture on the aponevrotic wall was used to reduce Gas leakage.…”

“…Anderson et al were the first to describe a laparoscopically assisted colostomy closure [3]. Since; many surgeons have tried the Laparoscopic Reversal of Hartmann's Procedure (RHP) with rather good results [4]. However it's not a standard of care and many surgeons prefer the conventional laparotomy approach.…”