Page 9 - World Journal of Laparoscopic Surgery

WJOLS
Laparoscopic Reversal of Hartmann’s Procedure
REVIEW ARTICLE
Laparoscopic Reversal of Hartmann’s Procedure

1 2
K Kilic, K Ulker
1
Medical Faculty, Department of General Surgery, Kafkas University, Kars, Turkey
2
Medical Faculty, Department of Obstetrics and Gynecology, Kafkas University, Kars, Turkey
Correspondence: K Kilic, Medical Faculty, Department of General Surgery, Kafkas University, Tip Fakultesi Genel Cerrahi
ABD 36200, Kars, Turkey, Phone: 90-505745-68-30, e-mail: kilic8@hotmail.com

Abstract
Objective: To assess the outcomes of laparoscopic and open reversal of Hartmann’s procedure.
Methods: Studies of laparoscopic reversal of Hartmann’s procedure with comparison of open approache are searched from medical
literature and outcomes of the approaches made.
Results: Laparoscopic reversal of Hartmann’s procedure with the advantages of smaller incisions, decreased postoperative pain,
shorter recovery time, and early return to normal activity may reduce morbidity rates. And laparoscopic approach has a clear
advantage over open approach for mobilization of the splenic flexure by avoiding an upper abdominal incision and its potentially
increased respiratory complications when mobilization is mandotary. The most commonly reported reason for conversion to laparotomy
was the failure to identify the rectal stump and conversion rate is between 4 to 22%. There are only two studies directly comparing
laparoscopic and open reversal approaches, up-to-date.
Conclusion: Laparoscopic reversal of Hartmann’s procedure for restoration of intestinal continuity can be performed with low morbidity
and a short hospital stay.
Keywords: Reversal of Hartmann’s procedure, laparoscopy, open, laparotomy, outcomes, complications.

INTRODUCTION METHODS
After the description of Hartmann’s procedure in 1923, by Recent medical literature for the complications of
Henri Albert Hartmann for the treatment of proximal rectal laparoscopic reversal of Hartmann’s procedure was
cancer, Hartmann’s procedure has been commonly used searched. Data were collected by using the online search
for conditions like distal large bowel obstruction, complicated engines like Pubmed, Highwire, Google and Google Scholar.
diverticulitis and colonic injuries that may be difficult and In the search we included the prospective, retrospective
unsafe for repair (ischemic and inflammatory colitis, studies and review articles. All the procedures that began
laparoscopically, even then converted, were included in the
traumatic perforation of the colon,volvulus and anastomotic
leaks). 1 Following the inital surgery of Hartmann’s study. Patients’ age at reversal, gender, anesthesiologic risk,
initial operation indication, comorbidities, operative time,
procedure, after the recovery of the patient, reversal of the
complications, postoperative bowel movements and hospital
procedure for bowel continuity maintanence is indicated. stay time were the concerns. Previous articles and their
Reversal procedure is a major abdominal surgery and has results were compared at the base of these parameters.
risks of mortality and morbidity. 2,3
After the expansion of Minimal Access Surgery (MAS) SURGICAL TECHNIQUE
techniques for colorectal surgery, with clear advantages of In the study of M Khaikinin et al in 2006, 6 all patients
low morbidity, less postoperative pain, shorter hospital stay, underwent preoperative mechanical bowel preparation, and
and an earlier return to normal life; articles about other a Fleet enema Fleet, Lynchburg, Virginia, USA was
administered to empty the rectal stump. In addition,
procedures such as reversal of Hartmann’s procedure were
published. 4,5 Although the successive studies support the perioperative broad spectrum parenteral antibiotics and
subcutaneous low-molecular- weight heparin were routinely
improved outcomes of the laparoscopic Hartmann’s reversal,
used. No ureteric catheters were used in this study. A
when compared with other laparoscopic surgeries this
Jackson-Pratt drain was placed through the lower abdominal
procedure’s improvement is beeing lagged. trocar site. The patients were placed in a modified lithotomy
Purpose of this review is to compare the outcomes of position with the legs only slightly flexed. Two video
laparoscopic and laparotomic Hartmann’s reversal procedure monitors were placed on the left side of the patient. The
to enlighten the surgeons while selecting the approach. surgeon and first assistant stood on the right side of the

World Journal of Laparoscopic Surgery, January-April 2010;3(1):7-11 7