Single-port laparoscopic reversal of Hartmann's procedure via the colostomy site

Choi, Byung Jo; Jeong, Won Jun; Kim, Young Kyun; Kim, Say-June; Lee, Sang Chul

doi:10.1016/j.ijsu.2014.12.026

Cited by 23 publications

(37 citation statements)

References 26 publications

(21 reference statements)

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“…Operating times and LoS in our study confirm the comparative benefits of SIL RoH over OS as in a small comparative series reported by Clermonts et al [26]. Our data are favourable to those reported in the non-comparative series of SIL RoH by Choi et al [27], although systemic differences in clinical practice may account for their rather long postoperative stay.…”

Section: Discussionsupporting

confidence: 87%

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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Section: Discussionsupporting

confidence: 87%

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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“…A review of the literature reveals that only a few small case series have been published on this technique. At the moment no randomized controlled trials were published [37][38][39][40][41][42]. Table 5 summarizes the results of the available literature.…”

Section: Appraisal Of the Literaturementioning

confidence: 99%

“…The patient started a clear liquid diet on postoperative day 2 and was discharged after 5 days. The largest study without control patients was that of Choi et al [40] and consisted of 23 patients. In one patient closure of the colostomy was aborted due to intraoperative difficulties.…”

Section: Appraisal Of the Literaturementioning

confidence: 99%

The Evolution of Minimally Invasive Techniques in Restoration of Colonic Continuity

Clermonts¹,

Stassen²,

Zimmerman³

2017

Laparoscopic Surgery

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Restoration of bowel continuity after Hartmann's procedure is considered technically challenging and is associated with high morbidity and mortality. This is the main reason why restoration of intestinal continuity is often not attempted. Over the past decade, considerable international experience has gained on this topic with new minimally invasive techniques being developed. This review details the evolution of minimally invasive techniques in restoration of colonic continuity after Hartmann's procedure. A comprehensive search of PubMed and Embase was done. Different restoration modalities were included. Eight studies, from six different countries, in which multiport laparoscopic restoration of continuity was compared to conventional open restoration of bowel continuity, were included. In the total of 254 patients, continuity was restored laparoscopically compared with 255 patients in which continuity was performed in open fashion. Restoration of bowel continuity via trephine access was also reported; three studies including 37 patients were included in this review. Single-port restoration of bowel continuity after Hartmann's procedure is a natural evolution of multiport laparoscopy and trephine access. Six studies reporting on single-port reversal of Hartmann's procedure were included with a total of 75 patients. Single-port access in combination with a transanal approach has also been reported; however, data are extremely limited as there is only one study in the published literature. Success of restoration of bowel continuity with less morbidity and mortality has been demonstrated throughout the evolution of the different surgical techniques. In this review advantages of different approaches for restoration of bowel continuity after Hartmann's procedure are discussed. Furthermore, surgical techniques are described, pictorial guides are added for some techniques, and flowcharts are given for easy use during clinical decision-making.

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“…But given the fact that laparoscopic Hartmann reversal is one of the most challenging interventions in minimally invasive colorectal surgery (21), with less than 20% of the reversal procedures being attempted laparoscopically, a good patient selection needs to be carried out (22). With new technological advantages, the minimally invasive approach to Hartmann reversal improves: trans-anal reversal (23,24) and single-port reversal (7,25).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Hartmann s Reversal: A Single Center Experience

Gavrilă¹,

Minciuna²,

Tudor³

et al. 2019

chr

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RezumatChirurgia colorectalã minimal invazivã prezintã numeroase avantaje în ceea ce priveşte morbiditatea, abordul laparoscopic utilizat în cazul repunerilor în tranzit dupã Hartmann îmbunãtãţind rata de repunere şi evoluţia postoperatorie. A fost analizatã baza de date a Institutului Clinic Fundeni, Departamentul de Chirurgie Generalã, fiind selectate cazurile de refacere a continuitãţii intestinale utilizând laparoscopia. Au fost identificate nouã cazuri, cu vârsta medianã de 63 de ani, cu o medie a BMI-ului de 29, dintre care trei pacienţi operaţi iniţial deschis. Timpul operator mediu a fost de 223 de minute şi nu au necesitat ileostomie de protecţie. Nu au fost raportate cazuri de dehiscenţã de anastomozã. Abordul laparoscopic rãmâne o alternativã fezabilã pentru repunerea în tranzit dupã operaţia Hartmann, luând în considerare experienţa echipei chirurgicale şi particularitaţile pacientului. Sunt necesare studii suplimentare pe loturi mai mari pentru a stabili clar avantajele acestui abord. AbstractMinimally invasive colorectal surgery showed multiple advantages in terms of morbidity, surgeons applied this approach to Hartmann reversal considering improving the reversal rate and postoperative

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Single-port laparoscopic reversal of Hartmann's procedure via the colostomy site

Abstract: In our experience, SP-LHR via the colostomy site was safe and feasible, and may be considered an additional surgical option for experienced SPLS surgeons in selected patients.

Cited by 23 publications

References 26 publications

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

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

The Evolution of Minimally Invasive Techniques in Restoration of Colonic Continuity

Laparoscopic Hartmann s Reversal: A Single Center Experience

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