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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
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            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)
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