Page 12 - World Journal of Laparoscopic Surgery

K Kilic, K Ulker

peratively. One of these patients had severe pulmonary and clinical data, along with distinct advantage for laparoscopic
comorbidities and required short postoperative mechanical group having shorter time to bowel function and
ventilation. The second patient was admitted to SICU for hospitalization. Both studies demonstrated lower morbidity
observation for 24 hours due to the surgeon’s request rates in laparoscopy group. Mazeh et al analyzed laparoscopy
because of the patient’s age and comorbidities. Three (7.3%) group patients that were converted to laparotomy. And they
major complications occurred in the open group (deep vein
found that these patients had a higher surgical site infection
thrombosis and reoperations) and one (2.4%) major rate than those that were not converted, suggesting that
complication occurred in the laparoscopy group
surgical site infection was not solely related to the colostomy
(enterocutaneous fistula). The overall complication rate in
site, but also associated with a long midline incision which
the laparoscopy group was significantly lower than in the
open group (26.8% vs 47.8%). There were no anastomotic is avoided in laparoscopy group. And establisment of
scheduled and specified training programs of laparoscopic
leaks, uretral injuries or intra-abdominal abscesses in this
series, and there were no mortalities. Findings at both the approach in clinic practices and residency programs, gaining
index and the reversal procedures were analyzed to compare of the surgeons the familiarity of various laparoscopic
differences between the laparoscopic completed and instruments and their operating principles (bipolar, monopolar
converted groups. No statistically significant difference was coagulation, different energy sources, camera, light source,
found when these criteria were compared between the two insufflators and hand instruments), laparoscopic ergonomy,
groups. anatomy and various operative techniques will aid in lowering
the complication rates.
DISCUSSION
Despite its obvious advantage for intestinal continuity, reversal CONCLUSION
of Hartmann’s colostomy is a major abdominal surgery with Laparoscopic reversal of Hartmann’s procedure for
prolonged recovery. In open reversal morbidity of 4 to 43% restoration of intestinal continuity can be performed with
was reported, with a wound infection rate of 5 to 24%, and low morbidity and a short hospital stay. The need for conver-
anastomotic dehiscence seen in up to 12%. 14-16 And the sion to open surgery is not depended the patients’ previous
17
mortality rate was reported to differ from 0 to 4%. Because
surgeries but the presence of dense adhesions and inability
of these risks 40 to 60% of patients refuses reversal. to mark the rectal stump. But more and large serious of
Laparoscopic reversal with the advantages of smaller
incisions, decreased postoperative pain, shorter recovery time, randomized, prospective studies are needed to clarify the
and early return to normal activity may reduce morbidity outcomes of laparoscopic and open approaches of reversal
rates. And laparoscopic approach has a clear advantage over of the Hartmann’s procedure. Surgical teams adequately
open approach for mobilization of the splenic flexure by and skillfully trained will open the doors of surgery with
avoiding an upper abdominal incision and its potentially minimal (may be non) complications.
increased respiratory complications when mobilization is
mandotary. 18,19 In laparoscopic approach clear view of the REFERENCES
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