Page 86 - World Journal of Laparoscopic Surgery

CLINICAL TECHNIQUE
Laparoscopic Reversal of Hartmann’s Procedure as a Primary

Treatment Modality: A Single-center Experience

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Leesa Misra , Jyotirmaya Nayak , Manash Ranjan Sahoo , Soumya Bharati Rout 4
AbstrAct
Aim: The aim of this study is to evaluate the results of laparoscopic reversal of Hartmann’s procedure assisted by transanal circular stapler as
a primary treatment modality.
Materials and methods: About 32 patients presenting with an end colostomy due to various elective and emergency surgical, gynecological,
and obstetric indications were selected for this study, from April 2010 to March 2016. All the patients were subjected to ultrasonography of the
abdomen and pelvis, a colostogram and contrast enema, and colonoscopy. Patients selected for the study were subjected to all routine workup.
Pre-anesthetic evaluation was done. Parameters such as operative time, conversion rates, intraoperative blood loss, postoperative complications,
return of bowel movements, starting on oral feed, anastomotic leak, port-site infection, and hospital stay were studied.
Results: About 32 patients, including both male (12) and female (20), were included in the study. The age ranged between 30 years and 65 years
(mean 47.5 years). The mean operative time was 150.6 ± 20.4 minutes. Four cases were converted to open. Oral feeds were started on 2 ± 1
postoperative day. Patients tolerated solid soft diet 96 hours after surgery. Postoperative hospital stay was 7 days (range 6–8 days). No patients
had anastomotic leak or required revision surgery. Three patients had port-site infections.
Conclusion: We conclude that transanal stapler-assisted laparoscopic Hartmann reversal can be considered as a primary modality of treatment
in the hands of an experienced surgeon though having a steeper learning curve and a higher difficulty score compared with other laparoscopic
colorectal surgeries with benefits of lesser intraoperative time, early return of bowel movements, faster initiation of oral solid feeds, decreased
incidence of anastomosis leak, and lesser hospital stay.
Keywords: Covidien EEA 31 mm circular stapler, Laparoscopic Hartmann reversal, Primary treatment modality.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1515

IntroductIon 1 Department of Obstetrics and Gynecology, SCB Medical College,
Hartmann’s procedure refers to a colon or rectal resection without Cuttack, Odisha, India
an anastomosis in which a colostomy is created, and the distal colon 2–4 Department of General Surgery, SCB Medical College and Hospital,
or rectum is left as a blind pouch. The term is typically used when Cuttack, Odisha, India
the left or sigmoid colon is resected and the closed-off rectum is Corresponding Author: Jyotirmaya Nayak, Department of Surgery,
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left in the pelvis. It is usually performed as a temporary procedure SCB Medical College, Cuttack, Odisha, India, Phone: +91 9438037714,
with the intent to reverse it. A colostomy is known to impact e-mail: drjmnayak@gmail.com
negatively on a patient’s quality of life. Hence, attempts to close How to cite this article: Misra L, Nayak J, Sahoo MR, et al. Laparoscopic
colostomies are of vital importance for the comfort of patients. Reversal of Hartmann’s Procedure as a Primary Treatment Modality:
Surgical approaches to Hartmann’s reversal include conventional A Single-center Experience. World J Lap Surg 2022;15(2):182–184.
open surgery and transanal stapler-assisted laparoscopic surgery. Source of support: Nil
In this study, we present our single-center experience over 6 years Conflict of interest: None
in transanal stapler-assisted laparoscopic Hartmann’s reversal as a
primary treatment modality.
minimum 130 days (range 130–400 days), the following Hartmann’s
procedure was taken as the criteria. All the patients were subjected
MAterIAls And Methods to ultrasonography of the abdomen and pelvis. A colostogram and
About 32 patients presenting with an end colostomy due to contrast enema were done to check the patency of the bowels and
various elective and emergency surgical, gynecological, and the status of the rectal stump. Colonoscopy was done to rule out any
obstetric indications were selected for this study, from the residual pathology. Patients selected for the study were subjected
period April 2010 to March 2016. In 32 patients included in to all routine workup. Patients with high comorbid conditions,
the study, Hartmann’s procedure was performed for recurrent undergoing radiotherapy and chemotherapy, and patients with
diverticulitis, colovesical fistula, volvulus with gangrenous bowel, any intra-abdominal malignancy were excluded from the study.
colonic diverticular perforation, traumatic rupture of left colon Pre-anesthetic evaluation was done. The proximal bowel and the
and rectum, MTP complications, and gynecological operation rectal stump were prepared prior to surgery. The patients were
complications. All the patients had their Hartmann’s procedure subjected to laparoscopic Hartmann’s reversal assisted by transanal
performed by conventional laparotomy. The study included tension-free intracorporeal stapler. Parameters such as operative
both males (12 patients) and females (20 patients). Age ranged time, intraoperative complications, blood loss, conversion rates,
between 30 years and 65 years (mean 47.5 years). With an interval of postoperative complications, return of bowel movements, starting

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