Surgical Endoscopy

, Volume 23, Issue 3, pp 496–502

Laparoscopic and open reversal of Hartmann’s procedure—a comparative retrospective analysis

  • Haggi Mazeh
  • Alexander J. Greenstein
  • Kristin Swedish
  • Scott Q. Nguyen
  • Aaron Lipskar
  • Kaare J. Weber
  • Edward H. Chin
  • Celia M. Divino
Article

Abstract

Background

Restoration of intestinal continuity after Hartmann’s procedure has traditionally required laparotomy. This study compares our experience with laparoscopic and open reversal of Hartmann’s procedure.

Study design

All laparoscopic and open Hartmann’s reversal procedures performed between January 1998 and June 2006 were reviewed. Patients with laparoscopic reversal were retrospectively matched by age, body mass index (BMI), and indication to controls with open reversal. Demographic data, perioperative course, and postoperative complications were documented.

Results

We identified 41 patients who underwent laparoscopic reversal of Hartmann’s procedure and these were matched to 41 patients with open reversal. The groups had similar average age and BMI. The predominant indication for surgery in both groups was diverticular disease. Conversion to laparotomy occurred in eight patients (19.5%), and was due to dense adhesions or difficulty in identification of the rectal stump. Adhesions were significantly greater in the conversion group (p <0.05), and the rectal stump was not marked in any of these cases. The most common short-term complications were ileus and surgical site infection. There were no anastomotic leaks and no mortalities. The mean operative times in the laparoscopic and open groups were 193 versus 209 min, respectively (p = 0.33). The laparoscopic group had a significantly lower estimated blood loss of 166 versus 326 mL (p < 0.0005), shorter time to bowel function return (4.1 versus 5.2 days, p < 0.05), and a shorter hospital stay (6.4 versus 8.0 days, p < 0.05). The major complication rate was also significantly lower in the laparoscopic group than in the open group (4.8% versus 12.1%, p < 0.05).

Conclusions

Laparoscopic reversal of Hartmann’s procedure is a safe and practical alternative to open reversal. It can be performed with similar operative time, fewer complications, and a faster recovery time. Conversion during the reversal procedure was significantly impacted by severity of adhesions and marking of the rectal stump.

Key words

Hartmann’s procedure Reversal Laparoscopy Colostomy closure 

Abbreviations

BMI

body mass index

LAHR

laparoscopic-assisted Hartmann’s reversal

OHR

open Hartmann’s reversal

PCA

patient-controlled analgesia

SICU

surgical intensive care unit

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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Haggi Mazeh
    • 1
  • Alexander J. Greenstein
    • 2
  • Kristin Swedish
    • 2
  • Scott Q. Nguyen
    • 2
  • Aaron Lipskar
    • 2
  • Kaare J. Weber
    • 2
  • Edward H. Chin
    • 2
  • Celia M. Divino
    • 2
  1. 1.Department of General SurgeryHadassah-Hebrew University Medical CenterJerusalemIsrael
  2. 2.Department of SurgeryMount Sinai School of MedicineNew YorkUSA

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