Page 88 - World Journal of Laparoscopic Surgery

Laparoscopic Reversal of Hartmann’s Procedure
undergone Hartmann’s procedure for various reasons, including
both elective and emergency conditions, were included. The timing
3
between the initial procedure and reversal is controversial. Longer
intervals will result in atrophy of the distal stump. A minimum period
of 130 days from Hartmann’s procedure to laparoscopic Hartmann’s
reversal was taken as the criteria in our study. This allowed in the
maturation of scar tissue and adhesions. Mean operative time was
150.6 ± 20.4 minutes. Four cases (12.5%) could not be continued
laparoscopically and were converted to open Hartmann reversal
and completed. Two cases were due to extensive adhesions,
and 2 cases were due to difficulty in accessing the rectal stump.
Laparoscopic Hartmann’s reversal resulted in minimal blood
loss intraoperatively, and no patient required blood transfusion
during surgery. All the patients were started on oral liquid diet
on the 2nd postoperative day. Patients tolerated solid diet 96
hours postoperatively. Postoperative pain was less due to small
incisions. In our previous experience, using the colostomy site as a
Fig. 6: An end-to-end intracorporeal anastomosis done by circular laparoscopic port showed increased incidence in port-site infection
stapler and difficulty in approximating the external oblique to be used
as a port site, hence, the colostomy site was closed temporarily
results and another 5-mm port was made. Three patients had port-site
During the study period between April 2010 and March 2016, 32 infections that were treated. None of the patients had anastomotic
patients, including both male (12 patients) and female (20 patients) dehiscence.
of age-groups ranging between 30 years and 65 years (mean In the advent of technological advancement and transanal-
47.5 years) were enrolled in the study. All 32 cases were posted assisted circular stapler reducing intraoperative time and
for transanal-assisted laparoscopic Hartmann’s reversal. Mean reducing incidence in anastomotic leaks, transanal stapler-assisted
operative time was 150.6 ± 20.4 minutes. Four cases (12.5%) were laparoscopic Hartmann’s reversal can be considered as primary
converted to open, 2 cases were due to difficulty in identification modality of treatment in the hands of an experienced surgeon
of rectal stump, and 2 cases were due to extensive adhesions. though having a steeper learning curve and a higher difficulty score
Intraoperative bleeding was minimal, no patient required blood compared with other laparoscopic colorectal surgeries.
transfusion. Oral feeds were started on 2 ± 1 postoperative day.
Patients were started on oral solid diet after 96 hours of surgery. conclusIon
Postoperative hospital stay was 7 days (range 6–8 days). Three This study demonstrates that transanal stapler-assisted laparoscopic
patients had port-site infections, which were treated. No patients Hartmann’s reversal can be a primary treatment modality in
had anastomotic leak or required revision surgery. reversal of end colostomy in the hands of experienced surgeons,
with benefits of lesser intraoperative time, early return of bowel
dIscussIon movements, faster initiation of oral solid feeds, decreased incidence
Hartmann’s procedure refers to a colon or rectal resection without of anastomotic leak, and reduced postoperative hospital stay.
an anastomosis in which a colostomy is created and the distal
1
colon or rectum is left as a blind pouch. It is usually performed as orcId
a temporary procedure with the intent to reverse it. Hartmann’s Leesa Misra https://orcid.org/0000-0002-7133-9250
reversal carries a high amount of operative morbidity and mortality.
Surgical approaches to Hartmann’s reversal include conventional
open surgery and transanal stapler-assisted laparoscopic surgery. references
Many studies have been published regarding the feasibility, 1. Charles Brunicardi F, Anderson DK, Billiar TR, et al. Schwartz’s
comparison of laparoscopic and open Hartmann reversals, and Principles of Surgery. 10th ed., Chapter 62. The United States of
America, an imprint of McGraw-Hill Education;2015. p. 1189.
case selection for Hartmann’s reversal. Laparoscopic Hartmann’s 2. Celentano V, Giglio MC. Case selection for laparoscopic reversal
reversal procedure remains a technically challenging procedure of Hartmann’s procedure. J Laparoendosc Adv Surg Tech A
associated with relatively high open-conversion rates reported even 2018;28(1):13–18. DOI: 10.1089/lap.2017.0132.
from high-volume centers, with less than 20% of cases attempted 3. Golash V. Laparoscopic reversal of Hartmann reversal. J Minim Access
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laparoscopically. In the present study, 32 patients who had Surg 2006; 2(4):211–215. DOI: 10.4103/0972-9941.28182.

184 World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022)