Laparoscopic reversal of Hartmann’s procedure: a hospital-based prospective observational study

Abstract

Background: Hartmann’s procedure involves surgical resection of the rectosigmoid colon with the closure of the anorectal stump and the formation of an end colostomy. After recovery from the initial surgery, colostomy reversal and restoration of bowel continuity are indicated in selected patients. The second stage procedure is associated with a considerable morbidity rate of 10% to 50% and a modest but genuine fatality rate. Laparoscopic reversal of Hartmann’s procedure is a safe and practical alternative to the open reversal method. Methods: This prospective observational study was conducted in the department of general surgery, GMC Srinagar over a period of 2 years after obtaining ethical clearance from the institutional ethical committee. Results: Our study included 40 patients between the age group of 32 to 67 years, with the highest incidence between 41 to 50 years. 32 males and 8 females with a ratio of 4:1. Mean operative time was 184.6±47.06 minutes. The conversion rate to open was 10%. The mean duration of hospital stay was 6.25±2.21 days. The mean time of return to normal work was 13.4 days. Postoperatively, two patients developed ileus which was managed in the immediate postoperative period and two suffered from adhesion obstruction, managed by diagnostic laparoscopy with adhesiolysis. It remained uneventful in the rest of the patients. Conclusions: Laparoscopic reversal of Hartmann’s procedure is safe, effective, and achieves faster positive results with significantly better short-term outcomes despite a proportion of patients being converted to open surgery.