Timing of colostomy reversal following Hartmann's procedure for perforated diverticulitis

Horesh, Nir; Lessing, Yonatan; Rudnicki, Yaron; Kent, Ilan; Kammar, Haguy; Ben‐Yaacov, Almog; Dreznik, Yael; Zbar, Andrew P.; Tulchinsky, Hagit; Avital, Shmuel; Mavor, Eli; Kashtan, Hanoch; Klausner, Joseph M.; Gutman, Mordechai; Zmora, Oded; Wasserberg, Nir

doi:10.1016/j.jviscsurg.2020.01.005

Cited by 10 publications

(10 citation statements)

References 26 publications

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“…There is no clear consensus with regard to the optimal time for reversal of Hartmann's procedure. In the existing literature, the average duration for reversal is seven to eight months after the primary Hartmann's procedure [10][11][12][13]. Contrastingly, our study reported an average duration of 22 months for laparoscopic reversal and 14 months for an open procedure.…”

Section: Duration Between Primary Hartmann's Procedures and Reversalcontrasting

confidence: 66%

Outcomes of Laparoscopic vs. Open Reversal of Hartmann’s Procedure: A Single Centre Experience

Nair¹,

Hanif²

2021

Cureus

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IntroductionHartmann's procedure is widely performed to fix colonic obstruction and perforation. It should ideally be followed by a reversal to restore bowel continuity. Reversal of Hartmann's procedure was traditionally performed using an open technique. However, in recent days, the use of a laparoscopic approach has become increasingly popular. In our retrospective observational study, we aim to investigate the outcomes of laparoscopic versus open reversal of Hartmann's procedure in a UK tertiary centre. MethodsAll patients who underwent reversal of their Hartmann's procedure between January 2017 and December 2019 were included in the study. Data including demographics, days between primary operation and reversal, laparoscopic or open reversal, length of hospital stay following reversal procedure, 30-day readmission, mortality, and complication rate were collected. Statistical analysis was performed using t-test and chi-squared test. ResultsForty-nine patients underwent reversal of Hartmann's procedure from January 2017 to December 2019. The mean age of our cohort was 59.6 ± 13.2 years. There was no significant difference in baseline demographics of both groups, apart from the number of days between the primary operation and reversal procedure. There was also no statistical difference in length of stay, 30-day readmission, and mortality between laparoscopic and open reversal techniques. However, there was a higher incidence of wound complications in patients who underwent open reversal of Hartmann's procedure. ConclusionThe reversal of Hartmann's procedure is a challenging operation. We found no significant difference between both open and laparoscopic approaches, but our study might be confounded by various factors including small sample size and selection bias. A larger, randomised study with greater statistical power is needed to confirm our findings.

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Section: Duration Between Primary Hartmann's Procedures and Reversalcontrasting

confidence: 66%

Outcomes of Laparoscopic vs. Open Reversal of Hartmann’s Procedure: A Single Centre Experience

Nair¹,

Hanif²

2021

Cureus

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“…A study has recommended a waiting period of 6 months to ameliorate the adhesion density and pelvic inflammation 8 . However, a recent study reported that the timing of surgery does not influence the postoperative complication rate, severity, or length of postoperative hospital stay 9 . We performed surgeries more than 6 months after the previous surgery given the effects of adhesion.…”

Section: Discussionmentioning

confidence: 99%

Standardization of laparoscopic reversal of the Hartmann procedure: A single‐center report

Yamamoto

Sakimura

Kitamura

et al. 2020

Asian J Endoscop Surgery

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Introduction Reestablishing continuity after the Hartmann procedure, the Hartmann reversal has been recognized as a complex procedure with a high morbidity rate. Laparoscopic reversal of the Hartmann procedure (LHR) is technically challenging, although good short‐term results have been reported. We formulated this technique in 2013 and have been gradually devising and standardizing it. Material and Surgical Technique Ten patients who had undergone the Hartmann procedure from January 2013 to December 2019 and subsequently LHR were retrospectively examined. During the procedure, a circular incision was made at the original site of the colostomy to safely reach the abdominal cavity, and pneumoperitoneum was performed using the glove technique. Next, pelvic adhesions and the descending colon were dissected. If the rectal stump was difficult to identify, an intraoperative endoscope was used. Finally, either a Gambee or stapled anastomosis without tension was performed. The median surgical time was 265 minutes (range, 160‐435 minutes), and the median blood loss was 100 mL (range, 10‐700 mL). The median postoperative hospital stay was 11 days (range, 8‐14 days). In one case, laparotomy was performed because of severe intra‐abdominal adhesion. Discussion No major complication was observed during or after surgery. Therefore, LHR can be performed safely. Standardizing this procedure could render it minimally invasive, although a high level of evidence is needed.

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“…De igual forma, en un metaanálisis del año 2020 se compara la seguridad y viabilidad del cierre temprano del estoma (cuatro semanas) con respecto al tiempo de cierre rutinario (ocho semanas). Dentro de los resultados, se encuentra que no hay diferencias significativas con respecto a complicaciones; sin embargo, el cierre temprano se asocia con una menor tasa de obstrucción intestinal y mayor riesgo de complicaciones en la herida quirúrgica como infección del sitio operatorio 49 .…”

Section: Discussionunclassified

“…Paralelamente, en cuanto a la técnica quirúrgica, estudios recomiendan que se realice vía laparoscópica, dado que muestra beneficios con respecto a la técnica abierta 46 . Esta vía es útil según la selección de pacientes con una baja morbilidad (16,6%) y mortalidad (0,7%), y una tasa de conversión exitosa del 11,7%, así como para una menor tasa de infecciones de sitio operatorio y menor necesidad de reintervención, además de la disminución en días de estancia hospitalaria (cinco versus seis días), lo que evidencia una significancia estadística en el procedimiento mínimamente invasivo al tener una mortalidad y tiempo quirúrgico similares 49 .…”

Section: Discussionunclassified

Intervenciones de Enfermería en la reversión del estoma intestinal: revisión integrativa

Barriga

Garzón

2022

Rev Cuid

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Introducción: los estomas intestinales representan un impacto significativo en la calidad de vida de las personas; sin embargo, estos deben revertirse después de haberse restituido el tránsito intestinal o la resolución del proceso inflamatorio inicial. Por otro lado, la negación de la persona para su reversión puede deberse a la falta de información y orientación por parte de los profesionales de la salud. Por lo anterior es importante identificar las intervenciones de Enfermería en la atención de la persona con reversión del estoma intestinal. Materiales y métodos: se realizó una revisión integrativa de la literatura de alcance descriptivo en el período comprendido entre los años 2015 a 2020, a través de las bases de datos Wos, Pubmed, Scopus, Scielo y Cochrane. Se seleccionaron 36 artículos que cumplieron con los criterios de inclusión y exclusión con el respectivo análisis metodológico. Resultados: Se identificaron las siguientes intervenciones de Enfermería, para el preoperatorio: valoración preoperatoria, preparación intestinal y seguimiento a comorbilidades. El intraoperatorio: profilaxis, preparación de la piel, técnica quirúrgica y cierre de la pared abdominal. En el posoperatorio: cuidado de la herida quirúrgica, calidad de vida y educación. Discusión: es importante la reflexión sobre el tiempo de reversión, la técnica quirúrgica y la importancia de las intervenciones por Enfermería. Conclusión: Enfermería cumple un papel importante en la reversión del estoma, no solo por los cuidados físicos y la educación que se brinda, sino también en las intervenciones aplicables al contexto social y emocional que afectan el estilo de vida de la persona. Como citar este artículo: Gómez Barriga Norma Yaneth, Medina Garzón Mauricio. Intervenciones de Enfermería en la reversión del estoma intestinal: revisión integrativa. Revista Cuidarte. 2022;13(1):e2165. http://dx.doi.org/10.15649/cuidarte.2165

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Timing of colostomy reversal following Hartmann's procedure for perforated diverticulitis

Cited by 10 publications

References 26 publications

Outcomes of Laparoscopic vs. Open Reversal of Hartmann’s Procedure: A Single Centre Experience

Outcomes of Laparoscopic vs. Open Reversal of Hartmann’s Procedure: A Single Centre Experience

Standardization of laparoscopic reversal of the Hartmann procedure: A single‐center report

Intervenciones de Enfermería en la reversión del estoma intestinal: revisión integrativa

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